Cool Medical Breakthroughs
The latest healthcare technology that could save your life
Groundbreaking medical innovations this year will change our lives – and hopefully even save them. Some anticipated breakthroughs seem to take us beyond the realm of science and into science fiction territory (think 3D-printed pills or gene editing), while others have less of a “wow” factor, but will still offer much-needed relief.
Compiling a definitive list of future medical game-changers is tricky. So,
The Weekly spoke to scientists, policy makers and pharmaceutical industry insiders to bring you some of the breakthroughs just over the horizon, that may have a profound impact on your health in the year ahead.
Immunotherapy for cancer
This cancer treatment uses the body’s own immune system to help fight the disease. Yet scientists at the Garvan Institute of Medical Research predict this revolutionary treatment will be the medical story of 2017.
Initially, immunotherapy was used to tackle melanoma, then a type of lung cancer. Now, it is being used (or tested in clinical trials) to treat a broad range of malignancies, such as bowel, pancreatic and bladder cancers. Scientists hope that immunotherapies may one day prove to be a “cure-all” for cancer; in much the same way that penicillin is the panacea for infections.
This year, the US Food and Drug Administration (FDA) is expected to approve the drug for the treatment of acute lymphoblastic leukaemia, triggering a wave of approvals for the treatment of other blood cancers and lymphomas. Scientists have long viewed immunotherapy as the holy grail of cancer treatments, but it’s proved incredibly difficult to make it work. Now, many oncologists believe we may have cracked it. While still used in conjunction with chemotherapy, it’ll hopefully supplant chemo, along with its horrific side effects.
Four years ago, Angelina Jolie announced she’d had a double mastectomy to prevent the scourge of her family’s breast cancer. In that courageous move, the film star splashed the subject of genetic testing for disease prevention across the front pages.
Single gene tests for disease risk – such as the BRCA1 gene Angelina carries – have been around for some years.Yet, increasingly, it is becoming possible to estimate people’s individual risk of a whole range of diseases by looking at patterns across their genome sequence (the six billion base pairs of DNA they carry in every cell). Call it what you will – personalised, genomic or precision medicine – this approach is aimed at both preventing disease and tailoring treatments. The Garvan Institute predicts that, this year we are likely to see clinical proof-of-principle studies that show how “genomic risk” can be used for early detection and prevention programmes, such as in cancer.
Beyond 2017, it will become more common for doctors to use genomic information as a first-line approach to the diagnosis of diseases. Doctors should then be able to determine how best to treat patients. By reading the clues in individual genome sequences, they will then be able to advise which drugs patients are most likely to respond to.
There is nothing more eagerly awaited in cardiovascular medicine than the results from a large clinical trial of a new cholesterol-lowering treatment.
Called PCSK9 inhibitors, this class of drugs has been shown in earlier trials to silence the gene that creates LDL (or “bad”) cholesterol. The outcome of the large Phase IIII trial should be known soon.
Cholesterol-lowering stales, the current standard-bearer in the fight against heart disease, have had a bad rap in recent years. While still regarded as safe and effective, their adverse side effects (such as muscle pain and weakness) cause many patients to discontinue therapy or take less than the recommended dose.
Experts say PCSK19 inhibitors could be a viable option for statin-intolerant patients. The FDA last year approved PCSK19 for high- risk patients, saying the drugs will likely be used more widely soon.
This is good news for Singapore: Cardiovascular disease is the largest single cause of death in females in Singapore and worldwide, says Dr Derek Yong, Medical Director at Restore Heart Centre at Mount Alvernia Hospital. “It affects more women than men, and is more fatal than all cancers combined, including breast cancer. Women should undergo a full medical checkup at least annually to check for cardiovascular risk factors such as diabetes mellitus, hyperlipidemia and hypertension.”
Up to one in three Singaporeans suffer from Iron Deficiency (ID), and many don’t know it, says cardiologist Dr David Yeo, consultant cardiologist and director at Apex Heart Clinic at Gleneagles Hospital and medical director at The Iron Suites Medical Centre. “Women of childbearing age, between 15 to 55, are especially prone to iron deficiency and anaemia, especially if they are pregnant or have prolonged menstrual bleeding.”
Iron deficiency causes shortness of breath, headaches and fatigue. It’s especially prevalent in patients suffering from heart failure, but a new treatment is promising significant improvements. Because iron in foods like liver and oral supplements aren’t efficiently absorbed by the body (only 10 per cent of oral iron in tablets is absorbed, according to Dr Yeo), intravenous iron replacements may be given to patients. These direct infusions of iron into the bloodstream are fully absorbed by the body, but require specialised care at facilities like The Iron Suites Medical Centre, Singapore’s first ID clinic.
Big Data perspectives
The past decade has seen huge advances in the amount of data we routinely generate, as well as our ability to integrate, curate, analyse, understand, store and share it. The intersection of these trends is what we call “Big Data” and the healthcare sector (and so all of us) will benefit.
Until recently, the huge amount of data collected by the medical industry has been siloed in archives controlled by different hospitals, surgeries, clinics and universities. Now, using advanced computing techniques, doctors can share all types of data – from symptoms and medications to test results – to improve patient care.
In Singapore, the National Electronic Health Record (NEHR) has been available to all public healthcare institutions since 2013. It lets healthcare professionals access key medical records in a patient’s history from other clinics or hospitals, to get a more complete picture of the patient’s health. The NEHR is expected to be extended to the private sector in coming years.
Big Data approaches, such as computer algorithms, can also detect patterns and trends to predict epidemics, improve quality of life, avoid preventable deaths and even cure disease. By using algorithms to analyse extremely large genetic and biological databases in this way, we should be able to find fresh uses for known drugs, accelerating the development of new treatments. Experts say it usually takes a decade and about US$1.3 billion to turn a laboratory finding into a successful drug treatment – Big Data breakthroughs could cut this to two years and about US$130,000.
Five years ago, researchers proved that they could perform microsurgery on genes, using a protein called Cas9 as a “scalper”. This gene editing technique, known as CRISPR, set off an explosion of research, with scientists using it to manipulate specific genes in mice, rats, bacteria, yeast, zebra fish, fruit flies and plants. Now, the first trials of gene editing in human embryos are underway in China. Scientists there have reported manipulating the genes of embryos to make them resistant to the HIV virus and also have edited genes linked to the sickle cell blood disorder. Other trials have been approved in the US and the Garvan Institute in Australia expects that these trials will really take off this year. This means that, in the future, we could be deleting – rather than treating – diseases.
Blood tests for cancer
Experts say it’s only a matter of time before diagnosing and treating cancer will be as routine as an annual check-up, thanks to so-called “liquid biopsies”. These simple blood tests look for cell-free circulating tumour DNA (aDNA), which is shed from a tumour into the bloodstream and is more than 100 times more abundant in the blood than tumour cells. Studies are still being conducted, but this technology may do away with invasive tissue biopsies. Several medical companies are developing test kits to hit the market next year and analysts expect huge demand, tipping annual sales of about US$13.1 billion.
Almost a decade ago, a new wave of diabetes drugs hit pharmacies, with promises to lower blood-sugar levels.Yet they failed to alleviate the scariest statistic for Type 2 diabetes sufferers – half of them will die from cardiovascular complications, with those odds rising to 70 per cent by 65.
Last year, two new drugs showed signs of slashing those mortality rates. Empagliflozin modifies the progression of heart disease by working with the kidney, while liraglutide has a comprehensive effect on many organs.
In light of these results, a distinguished panel of doctors and researchers, assembled by the Cleveland Clinic in the US, predicts that, this year, there will be a total shift in the line-up of drugs prescribed for diabetes, and as well as a wave of research into new avenues targeting Type 2 diabetes and its related diseases.
Hope for depression
According to the Singapore Mental Health Study conducted in 2010 by the Institute of Mental Health, as many as 1 in 17 Singaporeans have suffered from depression and for some, traditional antidepressants don’t really work. Their only option is intensive treatments, such as electroconvulsive therapy, where a light general anaesthetic and an electric current is passed through the brain for a few seconds. This treatment is only indicated for those with severe depression.
Diagnosing and treating cancer will be as routine as an annual check-up
In 2013, a study to see if ketamine – which is commonly used for anaesthesia and, less commonly, as a party drug – could alleviate treatment-resistant depression (TRD) produced overwhelmingly positive results: 70 per cent of TRD patients reported improved symptoms within 24 hours of being injected with a low dose of ketamine. As a result, the FDA expedited the development of new medications based on the ketamine profile and some, such as esketamine, are expected to be available to US patients shortly.
Self-administered HPV test
In Singapore, as in other developed countries, there have been huge strides in the treatment and prevention of the human papillomavirus (or HPV), the main cause of cervical cancer. Women here are urged to see their doctor for regular Pap smears, which can detect women’s cancers and sexually transmitted diseases. Yet, experts claim that the biggest prevention effort to date will soon take place, through large-scale deployment of self-administered HPV tests.
These tests – which include a test tube, a swab and a mail-in box – would allow you to administer the test and process the results in the privacy of your own home, rather than the discomfiting atmosphere of a doctor’s surgery. The convenience would allow many more women to perform the test, and seek medical assistance if necessary.
Many heart patients have metal stents inserted into their chests to treat coronary artery blockage. More often than not, the strut remains there forever, long after its mission has been accomplished. The struts can make some scans and future surgeries tricky, and lead to blood clots. Yet what if they could just vanish?
The first bioabsorbable strut was approved in the US last July. Made of a naturally dissolving polymer, it widens the clogged artery for two years before it’s absorbed into the body in a manner similar to dissolvable stitches. Experts assembled by the Cleveland Clinic are already hailing these stents as one of the top medical breakthroughs of 2017.
These emergency vehicles, which are available in the US and Australia, allow stroke victims to be treated quicker when time is of the essence. Equipped with a CR (Computed Radiography) scanner the size of a washing machine, a stroke ambulance will offer suspected stroke victims a brain scan in their driveway and access to timecritical therapy up to an hour earlier. About 80 per cent of strokes are caused by a blocked blood vessel in the brain and may benefit from a clot-busting drug, tPA.Yet the drug has to be taken within four hours of having a stroke, and unfortunately, it can be fatal in the 20 per cent of strokes that are caused by a haemorrhage.
Currently, only 7 per cent of eligible patients receive tPA as they don’t know exactly when the stroke occurred.The stroke ambulance will diagnose the type of stroke and deliver treatment. On board to assist stroke victims will be two paramedics, a radiologist, neurologist and nurse.
It took Earl Bakken, founder of US medical devices company Medtronic, just four weeks in 1957 to craft the first battery-powered pacemaker. His design barely changed for 50 years, but last year, Medtronic’s new model, the Micra, which is one-tenth the size and so small it can rest inside the heart itself, became the first of the next generation of pacemakers to be approved by the FDA. Unlike traditional pacemakers, which are implanted under the skin using an invasive procedure, the Micra is slipped through the femoral artery via the groin, using a catheter and docked inside the heart’s right ventricle. It operates without electrical wires that can break or get infected.
No more swallowing pills
Many people need to take medication daily, but find it difficult to swallow. Soon, this could be a thing of the past. In 2015, the FDA approved a new type of pill that is 3D-printed and dissolves into liquid when you take a sip of water. The pill, epilepsy drug Spritam, hit the US market last March. Its creators are looking at other disease areas, so more rapidly disintegrating drugs could be coming to a 3D printer near you.