the top10 medical advances of the decade
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Dr.T.V.Rao MD
MEDICAL ADVANCES(2001 TO 2011)
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The first decade of the21st Century brought anumber of discoveries,
mistakes, and medicaladvances that haveinfluenced medicinefrom the patient's
bedside to the medicinecabinet.
WHAT IS NEW IN THE LAST DECADE
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MAPPING THE HUMAN GENOME ADVANCES
MEDICINE
Mapping the human genome had become a raceof time and money in the 1990s, with twocompetitors at the forefront: the government-
funded Human Genome Project, whichcompleted its task in 15 years with more than $3billion in taxpayer money, and a private
company, Celera Genomics, which was financedwith $100 million and took less than a decade.
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" The biggest area of
the future will bepreventive medicine,".
"By understanding thegenetic causes andlinks to disease we canspend more and more
attention on preventingdisease."
GENOMIC SCIENCE ADVANCES PREVENTIVE
MEDICINE
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In 2003 a "final" draftwas released byresearchers, and in
2007 more updatesto the genome werepublished by Craig
Venter, PhD, chiefscientist behindCelera Genomics.
A CRAIG VENTER PUBLISHES THE
FINAL DRAFT
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Doctors have
developed a genetictest for a gene
associated withprostate cancer, "andthere's a drug availablethat greatly lowers the
risk for prostate cancerin the future."
GENETIC ASSOCIATION WITH PROSTATIC
CANCER DECODED
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Doctors say the Internetand information technologyhas actually changed theway they practice medicine
for the better. Even doctorsneed to look things up fromtime to time.
With a pad and pen, then
sit in the waiting room whilethe nurse pulls their file.
INFORMATION TECHNOLOGY TO
PATIENTS AND DOCTORS
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In the past if you had a clinicalquestion to research, I had to goto the library, pull out multipleyears of the Index Medicus, lookup the topic, write down thereferences, go to the stacks andpull the volumes of journals, findthe article, read the article, go tothe copy machine and make acopy& if I were lucky, I would
have my answer in about fourhours.
Now you have everything
at your finger tips
THE KNOWLEDGE AT YOU FINGER TIPS
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Now You can be on rounds andin five minutes have moreinformation on the topic than Ineed& on my iPod Touch or iPadI can look up a medication, checkthe formulary to see if it'scovered, check for interactionswith a patient's other meds anddouble-check details of thepharmacology of the med plus
quickly review the problem I amtreating, and You don't evenhave to go online
YOUR IPOD TOUCH OR IPAD BRINGS
EVERYTHING .
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Information technologyhas also, to somedegree, made life safer
for the patient. Onceadmitted to a hospital,they get a bar codewhich matches their
blood samples and theirIVs.
INFORMATION TECHNOLOGY MAKES
LIFE SAFE
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But many physicians havebeen reluctant to go digitalbecause there is asignificant upfront
investment, which is whyseveral of the healthcarereform measures nowbefore Congress include
provisions to underwritesome of this cost.
The developing countries
should go a long way ?
INFORMATION TECHNOLOGY SHOULD BE
SUPPORTED BY THE HOSPITALS ???
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In a report issued lastOctober, the Institute ofMedicine said those
public smoking banshave cut exposure tosecond-hand smoke,which, in turn, has
contributed to areduction in heartattacks and death fromheart disease.
ANTI-SMOKING LAWS AND CAMPAIGNS REDUCE
PUBLIC SMOKING -YES
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Anti-smoking campaigns (at leastin the U.S.), including banning ofsmoking in workplaces andpublic places, [have] enormousimpact across socioeconomic
classes on many diseases
In terms of the greatest
good for the greatest
number, there can be no
doubt that the decline insmoking (through various
means) has had the
greatest impact
ANTISMOKING LAWS HAVE IMPACT
ON SMOKING
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It's probably themost important
'doable' publichealth measurefor decreasing
morbidity andmortality,
ANTISMOKING LAW REDUCES
MORBIDITY AND MORTALITY
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Those looking for dramaticimprovements in public healthneed look no further than theworld of heart disease.
A mere 25 years ago,when a patient came to ahospital with a heartattack, the best that couldbe done was to put thepatient in a darkened
room, give him or hermorphine for pain andlidocaine, which doctorsbelieved would preventdangerous irregular
heartbeats, and hope forthe best.
HEART DISEASE DEATHS DROP BY
40 PER CENT
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Today treating a heartattack is all about speed:speed the patient to thehospital so that a clot that
blocks the life-saving flowof blood can be "busted"with drugs like thegenetically engineered
tissue plasminogenactivator or tPA.
GENETICALLY ENGINEERED DRUGS FOR
RESCUE IN HEART DISEASE
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Moreover, drugs that didn'texist 25 years ago -- chieflystatins like simvastatin,Lipitor, mevacor, and
Crestor -- are now routinelyused to slow theprogression ofatherosclerosis, the
medical term that describesthe build-up of the hard,waxy substance calledplaque that narrowsarteries.
NEW DRUGS CHANGES THE FUTURE OF
HEART DISEASES
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Research shows
about half of thegains in heart
disease came fromnew treatmentinterventions, the
other half (up to 60percent) are due toprevention.
PREVENTIVE CARDIOLOGY SOLVES MANY
ISSUES ON HEART DISEASES
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Importantly, what thismeans is that thecommunity 'gets it.'
Better control of bloodpressure, pre-emptivelowering of bloodcholesterol levels,
better diets, andreduced smoking areresulting in fewer(cardiac) events,
PROMPT SCREENING GREATLY HELPED
MANY PATIENTS
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Probably no area ofresearch has so firedthe public imagination
and so ignited the firesof public controversy asthat of stem cellresearch. In reality, this
area has generatedmore political actionthan reproducibleclinical advances
STEM CELL RESEARCH: LABORATORY
BREAKTHROUGHS AND SOME CLINICAL ADVANCES
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European researchersgenetically manipulatedbone marrow cells
taken from two 7-year-old boys and thentransplanted the alteredcells back into the boys
and apparently arrestedthe progress of a fatalbrain disease calledadrenoleukodystropy
GENETIC MANIPULATIONS HAVE CURE FOR
MANY CRITICAL DISEASES
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Now we can makeembryonic-like stem cellsdirectly from skin cells,which makes it possible to
model a multitude of humandiseases in the petri dish.New drugs based on stemcells are being developed,
and the first human clinicaltrial based on products ofhuman embryonic stemcells is expected
NOW WE CAN MAKE STEM CELLS TO OUR
NEEDS
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Two blockbuster-targetedtherapies burst on the cancerscene in late 1990s, andarguably changed forever theconcept of cancer treatment,
converting what was often a fataldisease into a chronic illness.The first, Herceptin, is a drugthat targets a type of breastcancer that is characterized by a
specific cancer gene -- anoncogene -- called HER-2.
TARGETED THERAPIES FOR CANCER
EXPAND WITH NEW DRUGS
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Women whose cancersexpress HER-2, whichis estimated to be about
25 percept of womenwith breast cancer, willrespond to Herceptineven when other
powerful chemotherapydrugs have failed.
NEW DRUGS ARE EFFECTIVE IN
CHEMOTHERAPY FAILURES
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The introduction/approval
of trastuzumab (Herceptin)and lapatinib (TyKerb) inbreast cancer will prevent
many women's breastcancers from recurring andhave significantly improvedsurvival for many women
faced with breast cancer.More important, thesedrugs represent highlyeffective agents that targetthe cancer, not the patient
NEW DRUGS CHANGES THE SOLUTIONS TO
CANCER
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Other drug, a cancer pillcalled Gleevec, targetsgenetic mutation called
bcr-abl (b.c.r. able) thatcauses cancer cells togrow and multiply inpatients with a variety
of cancers, includingchronic myeloidleukemia or with astomach cancer called
GIST.
NEW DRUGS TARGET GENETIC
MUTATIONS
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COMBINATION DRUG THERAPY EXTENDS HIV
SURVIVAL
Since the introduction of highly active antiretroviraltherapy, or HAART, as this combination therapyapproach is called, HIV/AIDS has evolved into a
serious, but chronic disease with survival stretchinginto decades.
Moreover, this "cocktail" approach to treatment wheredrugs are combined in different ways or differentsequences has become a model for treating otherdiseases ranging from lung cancer to heart disease.
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The drop in death rates from HIVin the developed world (is) due toimproved medications, "Therewas the 10 per cent drop indeaths due to HIV in the US
between 2006 and 2007.
In Africa, where the HIV/AIDScrisis hits hardest today, doctorsare slowly making progress-andin some cases real gains, whichis the case with the use ofantiretroviral drugs to blockmother-to-infant HIVtransmission.
BETTER APPROACHES IN
HIV INFECTIONS
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Advances are beingmade in the developingworld, with Botswana
leading the way not witha 3% verticaltransmission rate. Itwas the first and still is
the most effectiveprevention strategy
DEVELOPING WORLD TOO SHOW PROGRESS
IN REDUCTION OF VERTICAL TRANSMISSION
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Robotic surgery increased theability of cancer surgeons toget clean margins as well dueto the magnification of the
structures he greatest benefit of tiny
openings into the body ratherthan large incisions made bytraditional surgery, may --believers say -- be shorter andless painful recovery time .
MINIMALLY INVASIVE AND ROBOTIC
TECHNIQUES REVOLUTIONIZE SURGERY
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STUDY FINDS HEART, CANCER RISK WITH
HORMONE REPLACEMENT THERAPY
Until July 2002 most doctors treating middle-age womenbelieved that giving their patients hormones -- either oestrogenalone or oestrogen combined with progestin -- would protecttheir hearts from the ravages of age that seemed to attack
women after menopause. Hormone replace therapy, or HRT, was also thought to be good
for the bones, the brain, the skin, the figure, and the libido, andwas considered the best treatment to control the annoying andsometimes disabling symptoms of menopause such as hot
flashes, depression, and sleep disturbances
However research proves otherwise. >
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And then the worldchanged, the NationalHeart Lung and BloodInstitute, which was
sponsoring a placebo-controlled trial of hormonereplacement therapy inmore than 161,000 healthy
women, announced that itwas shutting down thestudy because HRTincreased the risk of heartattack, stroke, blood clots,and breast cancer.
HORMONE TREATMENTS CAN
INCREASE HEART DISEASE RISKS
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Two biggest advances
in breast cancer thisdecade was the
targeted-breast cancertreatment withHerceptin and "thefinding that
postmenopausalhormone replacementis associated with ahuge increase in the
risk of breast cancer."
HORMONE REPLACEMENT TREATMENT
LEADS TO INCREASED RISK OF CANCER
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Mind-reading has movedfrom carnival attraction tothe halls of medicine withwhat is known as a
functional MRI.
The medical mind-readersare not trying to identify acard randomly selected
from a deck -- they areusing sophisticated imagingtechniques to map the waythe mind works.
SCIENTISTS PEER INTO MIND WITH
FUNCTIONAL MRI
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A GREATER UNDERSTANDING
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The process, often called fMRI,traces the working of neurons --brain cells -- by tracking changesin the oxygen levels and bloodflow to the brain. The more brain
activity in one area, the moreoxygen will be used and themore blood will flow to that area.The patient lies awake inside anMRI scanner. He or she is asked
to perform a simple task, likeidentifying a colour or solving amath problem.
A GREATER UNDERSTANDING
WITH MRI
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As the patient answers thequestion, the fMRI tracksthe areas of the brain thatare activated by tracing the
speed at which the cellsmetabolize the sugar, orglucose.
First developed in the early
1990s, fMRI began toshape research at thebeginning of the decade
FMRI TRACTS REAL-TIME EVENTS ON
FUNCTIONALITY OF BRAIN
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Using this fMRItechnique, researchersare learning valuable
information aboutdisease such asdepression, braincancer, autism, memory
disorders, and evenconditions such as theskin disorder psoriasis.
BETTER UNDERSTANDING OF SEVERAL
DISEASES WITH F-MRIUSAGE
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CLONING OF MYCOPLASMA CHANGES THE
PRINCIPLES OF BIOLOGY
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Programme created by Dr.T.V.Rao MD
for Medical and Paramedical
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