2015 was an amazing year for medical advances
January 20, 2016
There were many advances in medicine in 2015, including significant developments in digital health. Innovation was seen in diagnostic and therapeutic areas with a heavy focus on improving personalization, as well as consumerization of healthcare. Here are the areas where I saw tremendous progress:
- PCSK9 Inhibitors – Cholesterol management advancements have been stagnant for many years. Cholesterol deposition and the oxidation of cholesterol deposits are the primary drivers of atherosclerosis. We have seen autosomal dominant hypercholesterolemia with low PCSK9 gene activity resulting in a change in LDL receptors in the liver. When PCSK9 binds LDL receptors, it loses function and LDL cannot be removed. The monoclonal antibodies were FDA approved in 2015 for lowering cholesterol where statins and other treatments were insufficient or not tolerated. This represents a significant advancement from the traditional statin therapies available since the 1980s and can help the 1 in 5 patients who cannot have their cholesterol lowered adequately.
- CRISP-R technology – Clustered Regularly Interspaced Short Palindromic Repeats (CRISP-R) are segments of DNA containing short repetition of base sequences with spacer DNA from bacterial virus or plasmids. Spacers can recognize and cut genetic elements and have application in altering genes of food crops and cutting, with gene editing enzymes, for genetic modification. Biomedicine and disease eradication (e.g. malaria) are two major applications heavily invested in by Bill Gates and others.
- Needle-less blood collection – Needles and vials are becoming things of the past, with companies competing for the holy grail of painless blood collection. Nanocontainers with microliters of blood are used to diagnose lipid panels and genetic analyses. Tasso Inc. has a disposable plastic device using a “vacuum collection system” from capillaries to collect minute amounts of blood through Hemolink. Of course, the technology is still under development, and Theranos has come under fire, with questions about its ability to accurately test for multiple conditions when extracting 25-50 microliters of blood into nanocontainers for diagnostics.
- Brain-limb connection – There have been major innovations in exoskeletons for use in spinal injury patients as well as commercial applications. The next step has been connection through brain implants to robotic limbs to empower amputees/paraplegics. These brain implants send signals about the intention to move as well as the movement itself to aid in activities of daily living.
- SPRINT study – This landmark trial delivered definitive results in a randomized control trial with multiple population including African Americans, elderly, male and females. It was terminated early due to its success. Over 9,000 patients were randomized to either intense blood pressure control with a goal of 120 mmHg or a standard goal of 140 mmHg. There was a positive outcome in tight control for a composite of myocardial infarction, stroke, heart failure and cardiovascular death. Overall death was also reduced by significant margins.
- The EMPA-Reg Outcome study – This was a landmark study for diabetic patients. Patients with Type 2 diabetes and cardiovascular disease had Empaglifozin (Jardiance) versus placebo. This SGLT-2 showed positive cardiovascular outcomes. The benefit on survival was seen regardless of the cause of death as Empagliflozin prevented one in three cardiovascular deaths, with a significant 38% relative risk reduction in cardiovascular mortality, as well as a significant 32% relative reduction in all-cause mortality.
- Telemedicine – The College of Physicians and Surgeons of Ontario created new guidelines for clinician visits and new regulations were created regarding inter-provincial delivery of care. There were increases in laptop utilization for the delivery of care as it has becomes cheaper to setup telemedicine practices. And with increased use, there is improved access to care for Canadians.
- Leadless cardiac pacemakers – These can be indicated in patients with slow heart rhythm and symptoms such as lightheadedness and loss of consciousness. A sensor electrode is implanted into the right ventricle and when an abnormal heart rhythm is detected, electrical signals are sent to the heart to beat. This has bypassed the need for tunneling leads through the venous system into the heart in a select patient population and is important in steps to reduce infected pacemaker systems and lead complications.
Last year brought many medical advances with landmark clinical trials. With the end of 2015, modern medicine has taken leaps forward in traditionally stagnant areas of care. In 2016, it will be interesting to see the therapeutic focus of healthcare professionals who pioneer health technology innovation.
Dr. Sunny Malhotra is a US trained Cardiologist who was named one of the top “Doctors on Twitter” to follow. He is an entrepreneur and health technology investor. He is the founder of Bookaclinic.com, a Canadian telemedicine practice in Ontario, Canada. He is the winner of Best in Healthcare – Notable Young Professional 2014 and the national Governor General’s Caring Canadian Award 2015.