By Marika Sboros | BD Live – Mon, Dec 31, 2012
TAKE out your crystal ball for a peek in the future of modern medicine, and the picture that emerges is bright.
Science fiction is becoming fact as modern medicine embraces hi-tech advances, along with surgical, procedural and pharmaceutical developments that boost the power to save lives, and fight off a host of serious illnesses.
It’s also true, though, that this “hymn of praise” is not the full picture. Medicine is increasingly being undermined by negative steps and doubts, a function in part of the relationship between doctors and drug companies that grows ever cosier, and which is proving to have an insidious effect on treatment guidelines.
Dr Eric Campbell is an associate professor at Harvard Medical School who has researched conflicts of interest in treatment guidelines, and is quoted as saying: “At the end of the day, the drug companies own medicine. We’ve created a system that allows this.”
That gives new meaning to the words of the late Austrian polymath, priest, polemicist and “jet-age ascetic”, Ivan Illich.
Illich, who died of cancer in 2002, worked in 10 languages and is widely acknowledged as one of the world’s great thinkers on education and medicine.
He once declared that the medical establishment “has become a major threat to health”, and that the “disabling impact of professional control over medicine has reached the proportions of epidemic”.
Still, the reality is many diseases once deemed untreatable now have a close to 100% recovery rate, and medical scientific breakthroughs continue to change lives and life spans for the better.
In my view, the most positive sign of a healthy future for modern medicine is the rise of what is known as “functional medicine”.
South African-born Dr Frank Lipman, who now lives and practises in the US, is already firmly on board. On his website (www.drfranklipman.com) he describes functional medicine as “a true combination of Chinese medicine, western medicine and scientific research”.
It combines Chinese medicine’s philosophy of balance and how to restore function, with the knowledge of biochemistry and physiology of western medicine and the latest scientific research about how our genetics, environment and lifestyle all interact with each other, Dr Lipman says.
It focuses assessment and intervention at the root levels of metabolic imbalance, he says. It is “an evolution in the practice of medicine that addresses the healthcare needs of the 21st century by focusing on prevention and uncovering the underlying causes of serious chronic disease”.
Instead of just treating and suppressing symptoms, as orthodox medicine does, functional medicine “deals with the root causes of disease, and is less concerned with making a diagnosis and more concerned with the underlying imbalances, which are the mechanisms of the disease process”, Dr Lipman says.
Here is a list (not exhaustive) of other medical developments to look forward to in 2013 and beyond:
A ‘new era’ in heart repair
US Cardiologists and molecular biologists from the University of Texas Southwestern Medical Centre have pinpointed a molecular mechanism needed to unleash the heart’s natural ability to regenerate. They say this research is a critical step towards developing therapies to repair damage suffered following a heart attack. It represents a “new era in heart regeneration biology”, with the promise of a “fresh perspective on an age-old problem”.
Your heart is naturally designed to repair itself. However, the fundamental mechanism that controls its natural regenerative on-off switch becomes faulty after myocardial infarction (as heart attack is known in medical terminology).
The Texas University team, led by Dr Hesham Sadek, assistant professor of internal medicine in the division of cardiology, say it will soon be possible to activate a programme of “endogenous (originating from within) regeneration”.
It involves the effects on heart function of a microRNA — a recently discovered class of non-coding RNAs that play key roles in the regulation of gene expression. This microRNA disables the regenerative capacity of the heart soon after an attack. Blocking this microRNA, allows the regenerative process to be sustained for longer.
Aid for ailing aneurysms
Aortic aneurysms are weak, ballooning areas in the heart’s largest artery, and are usually fatal in minutes if they rupture. The preferred treatment for large aneurysms (defined as more than 5.5cm-6cm in diameter) is a minimally invasive procedure to insert a stent graft in the affected area. However, stents currently on the market may not be suitable for up to 40% of patients, due to their anatomy. A new modular stent now in multicentre trials, approved by the US regulatory body, the Food and Drug Administration, allows surgeons to treat these complex aneurysms, thus saving the lives of high-risk patients.
US scientists at Stanford University Medical School will be spending $20m in human trials of a single drug, an antibody molecule that is looking good to beat seven types of deadly cancer. The molecule is already shown to combat cancerous tumours significantly in animal studies, and works by bypassing the body’s own immune system that goes awry, and helps cancer to take hold.
It is a cell marker protein known as CD47, usually found on the surfaces of blood cells. The researchers say it serves as a biological flag to immune cells, telling them: “Don’t eat me.” Cancer cells have found a way to wave the same flag, so that the body’s natural defence system (killer cells) leave them alone, they say.
Using the antibody molecule to block this “don’t eat me” signal inhibits the growth in mice of nearly every human cancer the researchers tested, with minimal toxicity, says Dr Irving Weissman, professor of pathology, who directs Stanford’s Institute of Stem Cell Biology and Regenerative Medicine and the Ludwig Centre for Cancer Stem Cell Research and Medicine.
“This shows conclusively that this protein, CD47, is a legitimate and promising target for human cancer therapy,” Weissman says.
The research was published online in March 2012 in the Proceedings of the National Academy of Sciences.
In other research, Australian cancer expert Prof Ian Frazer, who developed the world’s first cervical cancer vaccine, is working on developing a vaccine that will eradicate skin cancer.
“In my lifetime we should be able to remove the threat of skin cancer from the next generation,” the University of Queensland immunology professor and former Australian of the Year says.
A ‘golden age’ of prostate cancer treatment
A new type of hormone treatment significantly extends life and improves quality of life in men with advanced prostate cancer, say UK scientists.
The drug is the fourth promising lead in two years. Experts say these drugs and others in the development pipeline could ultimately turn advanced prostate cancer into a manageable chronic disease.
Institute of Cancer Research, London, and its partner hospital The Royal Marsden National Health Service Foundation Trust jointly led the new phase 3 trial of enzalutamide and the phase 3 trials of two other drugs, cabazitaxel and abiraterone. Abiraterone was also discovered at The Institute of Cancer Research.
Another drug, sipuleucel-T is shown to extend life in the two-year period.
The institute’s CE, Prof Alan Ashworth, says cancer research is finally delivering new treatment options for men with advanced prostate cancer after a long period of limited options.
“Advanced prostate cancer is extremely difficult to treat,” says Prof Ashworth. “It has taken a massive co-ordinated effort to finally bring new drugs into the pipeline, after decades where there were no options once old-style hormone treatment stopped working.
“What we’re seeing now is an unprecedented period of success for prostate cancer research. It truly is a golden age for prostate cancer drug discovery and development.”
Also called breast tomosynethesis, this form of diagnostic imaging technology involves taking dozens of images at various angles in a quick arc over the breast, that are then merged into a 3D image. It can be performed along with a traditional mammogram, and provide what experts say will be much more accurate screening. Preliminary study results of a study of 25,000 women by a team of international researchers reported a 47% rise in cancer detection when tomosynethesis was used.
However, specialists say no conclusion can be drawn until the full results are published in a peer-reviewed journal. There is also concern that the procedure can give women twice as much radiation as a standard mammogram, because women who have 3D imaging have traditional 2D mammography as well, and radiation is a known cause of breast cancer.
Still, specialists say the total radiation dose from 3D mammography is relatively low, and a woman’s total radiation dose may not necessarily increase if she has a 3D mammogram, as the procedure could help her avoid radiation from repeat scans.
‘Bladeless’ surgery for cataracts
Laser-assisted surgery is a relatively recent, hi-tech option to produce better vision after cataract surgery, compared with traditional approaches.
The latest development involves the use of a computer-guided “femtosecond” laser to dissolve cataracts in the eye. A femtosecond is the speed at which the laser pulses — in this case a quadrillionth (one millionth of one billionth) of a second.
Surgery is bladeless, and the equipment involves a machine called an optical coherence tomographer (OCT), used to create a detailed three-dimensional image of the inside of the eye. This allows the surgeon to plan, individualise and perform the entire procedure with what some specialists claim are “unparalleled levels of accuracy”.
The procedure takes just a few minutes, compared with about 30 minutes required of the traditional method.
Pain relief for severe headaches
A tiny, almond-sized implant can block the pain of excruciating migraine or cluster headaches without drugs. The implant, known as neuromodulation therapy, involves a nerve stimulator placed inside a small surgical incision in the upper gum. Patients can then activate the pain-blocking implant with a remote control whenever they feel a headache coming on.
In European studies, 68% of patients with cluster headaches responded to neuromodulation therapy with pain relief, fewer headaches, or both. The device is now being studied for migraines as well.
Nanotechnology and the ‘holy grail’ of diabetes medication
Novo Nordisk is competing with other drug makers to develop what is set to be one of the biggest blockbuster drugs in decades — oral insulin. The company is reported to be spending at least $2bn to make an insulin pill that can overcome the body’s own defence mechanisms and deliver insulin to the bloodstream.
“The odds of making it were a million to one five years ago,” Novo chief science officer Mads Krogsgaard Thomse says in a Bloomberg report. “Are we getting closer to a 50-50 scenario? Absolutely.”
Scientists have long been searching for a form of oral insulin. The search has been hampered by enzymes in the stomach and intestines that break down insulin before it can be absorbed into the bloodstream.
Options being investigated currently include fabricating a porous silicone particle that can travel across the intestinal cell wall and deliver insulin instantly to the blood.
If any one works, it will be like finding the diabetic “holy grail” — oral insulin — say experts.