Top medical innovations treat headaches, diabetes

by Debra Sherman

The best medical innovations for next year include an almond-size device implanted in the mouth to relieve severe headaches and a handheld scanner resembling a blow dryer that detects skin cancer, the Cleveland Clinic said on Wednesday.

The clinic's annual list of the best medical innovations for 2013 includes better mammography technology and new drugs to treat advanced prostate cancer.

Leading the 2013 list for innovations is an old procedure that has a new use due to findings in a recent study. Physicians and researchers at the clinic voted weight-loss surgery as the top medical innovation, not for its effectiveness in reducing obesity, but for its ability to control Type 2 diabetes, the most common form of the disease.

Over the years, bariatric surgeons noticed that the procedure would often rid obese patients of Type 2 diabetes before they even left the hospital.
Dr. Philip Schauer, head of the Cleveland Clinic's Bariatric and Metabolic Institute, led a study examining this phenomenon, and the prestigious New England Journal of Medicine published the results earlier this year.

"Bariatric surgery has been around for a while," Cleveland Clinic Chief Wellness Officer Dr. Michael Roizen said in an interview. "The reason it was chosen as the top innovation is because Medicare has broadened its indication for payment, and Medicaid in many states follows Medicare. A lot of the other (private) insurance companies started covering it, so it's much more accessible."

The criteria that insurers use to cover the surgery has been broadened because of its effectiveness in controlling Type 2 diabetes, he said.
The number of people affected by diabetes has tripled over the past 30 years to more than 20 million Americans, according to the Centers for Disease Control and Prevention. More than 90 percent of those cases are Type 2, a condition in which the body does not produce enough insulin or the cells ignore the insulin.
Doctors and researchers at the Cleveland Clinic voted for what they thought were the biggest, most significant innovations from the 250 ideas submitted from their colleagues. Roizen said one of the main criteria for getting on the list is the number of people that the product or procedure can potentially help.
For that reason, a device that helps relieve headaches, the second-most common ailment after the cold, was second on the clinic's list.
The miniaturized device - invented at the Cleveland Clinic and spun off into a separate, private company called Autonomic Technologies Inc - is implanted in the upper gum above the second molar to treat cluster and migraine headaches. A lead tip of the implant is placed near specific nerves behind the bridge of the nose.
When the patient feels the headache coming on, a remote control device is placed on the outside of the cheek, and the device delivers stimulation to those nerves, blocking pain.
The implant is available in Europe, but not in the United States. The company needs to do more studies to get approval from the U.S. Food and Drug Administration, said Dr. Frank Papay, department chair of the clinic's Dermatology and Plastic Surgery Institute and a consultant to Autonomic Technologies.
A handheld device used to detect melanoma, the most deadly form of skin cancer, was also on the list.

"Up until now, we've counted on our eyes," Dr. Allison Vidimos, who chairs the clinic's dermatology department, told Reuters. "This device offers an objective look underneath the skin using a special spectrum of light."

It compares moles and other marks on the patient's skin with a large database containing information on all types of melanoma. It also rates the risk.
"All dermatologists fear missing melanomas," Vidimos said. "The cure rate can be close to 100 percent if caught early."
Vidimos said using a device, manufactured by Mela Sciences Inc and approved by FDA last year for use by trained dermatologists, helped prevent unnecessary biopsies. The Mela scanner is also approved in Europe.
Verisante Technology Inc also makes a scanning device, which is approved in Canada, Europe and Australia. It has applied for U.S. approval, the company said.
Also on the list is a new type of mammography, called breast tomosynthesis. This technology provides greater detail of the image than the standard mammography, which renders a two-dimensional image.
For the patient, it may seem like there's no difference. "You still have the squish," said Dr. Alice Rim, the Cleveland Clinic's section head of diagnostic radiology. But the images produced by the new technology show the breast in slices, for more visible detail.
"With two-dimensional mammography, there are shadows, so it can be like a polar bear running around in a snowstorm," Rim said. "This eliminates the shadows, allowing increased detection and fewer call backs (for a second mammography)."

Other devices that made the list include mass spectrometry that allows microbiology laboratories to identify the type of bacteria in infections sooner and with more specificity, a new modular stent graft to treat complex aortic aneurysms, and a laser for cataract surgery.

Novel drugs to treat advanced prostate cancer were on the clinic's list because of their ability to halt the progress of the disease by blocking testosterone receptors.

A new technique to repair and regenerate damaged lungs, called ex vivo lung perfusion, is on the list. Experts say as many as 40 percent of previously rejected donor lungs may now be suitable for transplantation after undergoing this novel "lung washing."

The procedure involves placing donor lungs into a bubble-like chamber connected to a cardiopulmonary pump and ventilator. Over four to six hours, the lungs are repaired as special fluids are forced through the blood vessels. Nutrients are used to recondition the lungs as they inflate and deflate.

The final item on the list is neither a procedure, a drug nor a device, but healthcare programs that use incentives to encourage people to take better care of themselves.

For example, the Medicare Better Health Rewards Program Act of 2012 provides incentive payments to Medicare participants who voluntarily establish and maintain better health.

"We are seeing efforts to avoid rationing of healthcare and seeing programs with incentives built in if people maintain their health," Roizen said. "This can radically change the cost of care.

"We're seeing this more in big companies, the GE's and J&J's of the world. All companies are looking at how much they are spending on healthcare, and they are looking at ways they can reduce spending without rationing."