The Cleveland Clinic's list of top medical innovations for 2013 delivers the gee-whiz factor—a procedure for “cleansing” donor lungs and an almond-sized device implanted in the gums to relieve migraine headaches. It also praises important, if less splashy, advances such as new drugs for advanced prostate cancer and a proposed government-sponsored wellness program.
The annual list, now in its seventh year, is compiled by a group of the health system's scientists and physicians, and it recognizes procedures, devices, therapies and programs that are poised to play a pivotal role in shaping patient care in the upcoming year.
Topping this year's rankings is the use of bariatric surgery to control Type 2 diabetes. While weight-loss surgery has been around for decades, new research has shown that patients who undergo the surgery are far better able to maintain weight loss and reverse or stave off the onset of Type 2 diabetes, the Cleveland Clinic said in a news release announcing the list.
“Many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes—and not as a last resort,” the system said in the release.
Dr. Philip Schauer, director of the Cleveland Clinic's Bariatric and Metabolic Institute, led multiple studies examining the effects of bariatric surgery on diabetes, the most recent of which, published in April in the New England Journal of Medicine, found that patients who underwent surgery were much more likely to be able to control their disease than patients who only received medical therapies, such as counseling, drugs and weight management.
“The new data are very convincing,” said Claude Bouchard, professor of genetics and nutrition at the Pennington Biomedical Research Center, at Louisiana State University in Baton Rouge. Bouchard was co-author of another study, published in August in the New England Journal of Medicine, which found bariatric surgery to be highly effective at preventing or reversing Type 2 diabetes among a group of Swedish patients. “The results were pretty spectacular.”
Many of the innovations featured on the list sound futuristic, like a procedure that oxygenates and repairs donor lungs in a special chamber outside the body to make them more suitable for transplantation.
Dr. Thomas Egan, a professor of surgery at the University of North Carolina, Chapel Hill, is leading a National Institutes of Health-funded study of the procedure—known as ex vivo lung perfusion—and says it could substantially expand the pool of potential lung donors.
“I think it's a major advance, particularly if it can be applied to lungs taken from people who have died,” Egan said. “That would open up transplantation enormously.”
Selecting the top innovations is a long and detailed process involving a broad-based call for nominations, more than 100 expert interviews and two 18-member elimination panels, said Dr. Michael Roizen, Cleveland Clinic's chief wellness officer and head of the selection committee.
Also recognized on the list were a hand-held device that scans for melanoma without cutting the skin and mass spectrometry systems—which measure mass of molecules—that can more quickly and accurately identify bacteria.
The Medicare Better Health Rewards Program Act of 2012, a bill that would establish a voluntary incentive-based wellness program for participating beneficiaries, was also named as a top innovation. “What I was especially impressed with was the breadth and range,” Roizen said of the list. “Everything from technology to medication to procedures to insurance plans. That's the broadest I can remember us being during the last seven years.”