The top10 Medical Advances of the Decade

8/3/2019 The top10 Medical Advances of the Decade

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Dr.T.V.Rao MD

MEDICAL ADVANCES(2001 TO 2011)

DR.T.V.RAO MD 1


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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

DR.T.V.RAO MD 2


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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.

DR.T.V.RAO MD 3


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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

DR.T.V.RAO MD 4


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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

DR.T.V.RAO MD 5


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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

DR.T.V.RAO MD 6


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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 .

DR.T.V.RAO MD 9


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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

DR.T.V.RAO MD 20


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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

DR.T.V.RAO MD 32


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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

DR.T.V.RAO MD 33


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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

DR.T.V.RAO MD 34

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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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DR T V RAO MD 39

Programme created by Dr.T.V.Rao MD

for Medical and Paramedical

Professionals in the Developing World

Email

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The top10 Medical Advances of the Decade

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