Medical Innovations for the Year Ahead

Cleveland Clinic announced its “Top 10 Medical Innovations of 2018” at its 2017 Medical Innovation Summit this fall.

To receive consideration, nominated technologies had to:

• Have significant clinical impact and offer significant patient benefit in comparison to current practices. It must also have high user-related functionality that improves healthcare delivery.
• Have a high probability of commercial success.
• Be in or exiting clinical trials and be available on the market sometime in the coming year.
• Have significant human interest in its application or benefits and must have the ability to visualize human impact.

They are (in order of anticipated importance):

1. Hybrid closed-loop insulin delivery system, which enables direct communication between the continuous glucose monitoring device and insulin pump. (No human intervention needed.)
2. Neuromodulation to treat obstructive sleep apnea, an implant that delivers stimulation to open key airway muscles during sleep (because some 40 percent of sleep apnea patients refuse to wear continuous positive airway pressure (CPAP) devices.
3. Gene therapy for inherited retinal diseases, expected to receive FDA clearance in 2018, which delivers a new gene to targeted cells in the body via viral “vectors” to provide visual function improvements in some patients with genetic mutations.
4. The unprecedented reduction of LDL cholesterol, with a new class of cholesterol-lowering drugs (PCSK9 inhibitors), which have the potential of reducing LCL by 75 percent.
5. The emergence of distance health, or telehealth. In 2018: Hospitals are said to be getting ready for widespread adoption; as many as 7 million patients (a 19-fold increase from 2013) are predicted to use telehealth; and more than 19 million patients are projected to use remote monitoring devices (e.g., attachable devices that record and report medical information to healthcare providers).
6. Next-generation vaccine platforms, including new mechanisms to develop and deliver vaccines to vast populations, as well as new ways to deliver the vaccines to patients (e.g., oral, edible and mucosally delivered).
7. Arsenal of targeted breast cancer therapies to supplement hormone therapy, chemotherapy and radiation, including PARP inhibitors for patients with specific mutations in BRCA1 or BRCA2, and novel CD K 4/6 inhibitors for ER-Positive/HER-2-negative breast cancer.
8. Enhanced recovery after surgery, that is, protocols that permit patients to eat before surgery (which limits opioids by prescribing alternate medications) and encourage regular walking (which reduces complication rates and speeds recovery.) These protocols can reduce blood clots, nausea, infection, muscle atrophy, hospital stay and more.
9. Centralized monitoring of hospital patients, as part of a “mission control” operation in which offsite personnel use sensors and high-definition cameras to monitor blood pressure, heart rate, respiration, pulse oximetry and more. Complex data are assimilated to trigger onsite intervention when appropriate, while filtering out many unimportant alarms, which can lead to “alarm fatigue” on the part of busy caregivers.
10. Scalp cooling for reducing chemotherapy hair loss, cleared for marketing by the FDA in May 2017, which reduces the temperature of the scalp a few degrees immediately before, during and after chemotherapy (and has been shown to be highly effective for preserving hair in women receiving chemotherapy for early-stage breast cancer).