Technologies to diagnose bacterial disease, scan for melanoma and tackle headaches are among the hottest tickets in healthcare innovation for 2013

Each year the renowned Cleveland Clinic in Ohio brings together physicians to gaze into their (admittedly well informed) crystal ball, and evaluate what are likely to be the hot tickets for healthcare innovation in the coming year.

Approaches that make the Cleveland Clinic’s Top 10 Medical Innovations for 2013 include technologies to tackle headaches, to diagnose bacterial disease, to scan non-invasively for melanoma and even to boost the number of lungs available for transplant.

Chris Coburn, executive director of Cleveland Clinic Innovations (CCI), offers us his insights about the predictions. CCI is the corporate venturing arm of Cleveland Clinic, and the clinic’s 55 spin-out companies have to date raised more than $650 million in equity investment.

10 Health insurance/Medicare Programme/Rewards for better health

Rising health costs are being driven in part by chronic diseases. The bipartisan Medicare Better Health Rewards Program Act of 2012 has been presented to US Congress as a way to improve healthcare and control costs for Medicare participants – the three-year programme aims to encourage people to take a more active role in their well-being by developing and maintaining healthy habits.

“This is a reflection of what is going on in terms of healthcare reform and the search for any possible approach to better incentivising patients to manage their own health affairs,” says Coburn.

9 Digital breast tomosynthesis

This form of “3D mammography” can be performed along with a conventional mammogram to provide a more accurate view of the breast.

During the mammogram the X-ray arm of the machine travels quickly in an arc over the breast, taking dozens of images at a number of angles that can then be combined to build up a three-dimensional image. The approach helps to visualise small cancers obscured by surrounding tissue. “It is nice to see a technology on this list that more directly addresses women’s health,” says Coburn.

8 Modular devices for treating complex aneurysms

An abdominal aortic aneurysm, or weakness in the wall of the aorta in the abdomen, can have catastrophic consequences if it ruptures.

Large or leaking aneurysms can sometimes be treated through a minimally invasive procedure using a stent graft, but many patients have anatomies that are not suitable for the grafts.

The concept here is a modular stent graft system that can be quickly customised to suit the patient.

“This modular design allows you to work around difficult anatomy, whether it’s bends or tortuous aspects, or that the aneurysm is adjacent to one of the exiting arteries from the aorta,” says Coburn. “It enables the customisation of a very important procedure to meet the needs of the patient.”

7 Ex-Vivo Lung Perfusion

This technology stands to increase the number of lungs available for transplant by “washing” the removed donor lung to address injury and improve the quality of the organ.

The donor lung is put in a bubble-like transparent chamber connected to a cardiopulmonary pump and a ventilator.

The organ is then exposed to special fluids, nutrients and oxygen, and in some cases targeted medications. And once it’s deemed viable, it’s ready to be transplanted.

“It offers the ability to increase the candidate pool,” says Coburn. “Fully deployed, it’s estimated there might be as much as a 40 per cent increase.”

6 Femtosecond laser cataract surgery

Cataracts are a leading cause of vision impairment, but surgery can remove the damaged tissue and implant a new intra-ocular lens.

Femtosecond lasers enable a “bladeless” cataract procedure that makes a circular hole in the lens capsule, splits the lens into sections and then softens and breaks up the cataract.

“It is very quick, very precise and – pardon the pun – a cutting-edge technology,” says Coburn.

“The concept here is the reliability and speed at which you can treat a large number of patients.”

5 Hand-held optical scan for melanoma

Melanoma is on the increase in many parts of the world, and early detection is important so the malignancy can be removed in good time.

This innovation is a hand-held device that a dermatologist can use in an office.

It shines lights of several wavelengths on the area to visualise the small blood vessels just below the surface of a mole or lesion, all without needing to cut the skin.

In this way the doctor can assess the patient without the need for biopsy and the potential scarring that could involve.

“The panel was impressed that this technology is so available and simple to use,” says Coburn, describing how one of the panel had been moved to use the term “game-changer”.

4 Drugs for advanced prostate cancer

The last couple of years have seen several drugs approved by the US FDA for advanced prostate cancer, and further developments are expected.

So perhaps this innovation’s spot on the list is akin to the “lifetime achievements” award – but there is more on the way.

“I think the panel felt here there had been such a consistent increase of new therapies for prostate cancer that they needed to recognise that,” says Coburn.

“It really was an acknowledgement of technologies that have broken through, and there had been enough action to acknowledge that treatment of prostate cancer has improved.”

3 Mass spectrometry for bacterial identification

If a patient has a serious bacterial infection, getting that diagnosis quickly and giving the appropriate medication can make all the difference.

Developments in mass spectrometry mean it’s now possible to identify bacteria from a patient sample in minutes rather than in days.

“It’s a combination of capabilities, of bringing existing mass spectrometry technology to bear,” says Coburn.

“There is a lot of enthusiasm in the pathology community and this will enable rapid turnaround and accelerate the treatment of patients.”

2 Neuromodulation device for cluster and migraine headaches

Migraine and cluster headaches cause enormous human misery and loss of productivity.

The innovation here is a miniature, implantable, on-demand stimulator for the sphenopalatine ganglion nerve bundle behind the face. Once it’s in place, the patient can control the device to help block pain.

“The procedure typically takes 45 minutes or less to implant it, going up above the gums to get to the roof of the mouth. There is no scarring,” says Coburn. “It’s really elegant technology and the early results are astounding.”

1 Bariatric surgery for control of diabetes

Type 2 diabetes is a serious health issue, and the risk of developing the chronic condition increases with obesity.

Recent studies have been finding that bariatric surgery – which alters the gastrointestinal tract to reduce energy uptake – can play a role in controlling Type 2 diabetes.

“Clearly bariatric surgery itself is not new, though there is some new technology,” says Coburn. “But the demonstration that this hideous disease, Type 2 diabetes, could be reversed was groundbreaking in the view of our panel.”

For more on the Cleveland Clinic's Top 10 Medical Innovations for 2013, including short videos and a link to the associated app, see toptenmedicalinnovations.com

Top spot What of 2012’s number one prediction?

Towards the end of 2011, the Cleveland Clinic issued its top 10 predictions for 2012.

Number one on that list was a minimally invasive procedure to target nerve connections to the kidney as a means of addressing chronic high blood pressure that isn’t responding to drugs.

Several companies are now developing devices around this technology.

Chris Coburn, executive director of Cleveland Clinic Innovations, reckons the prediction was right on the nose with that one.

“That was huge, that played out exactly as they thought,” he says.