Our picks for the next big changes in healthcare
An artificial pancreas to help diabetics. A pacemaker for sleep apnea. Gene therapy for blindness. These are some of the innovations that will change healthcare in 2018, according to a panel of Cleveland Clinic physicians and scientists led by Chief Wellness Officer Michael Roizen, MD.
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The Top 10 Medical Innovations of 2018 were announced as the culminating event of Cleveland Clinic’s Medical Innovation Summit, held in Cleveland, October 23-25, 2017.
Here they are, in order of anticipated importance:
Hailed as the world’s first artificial pancreas, the hybrid closed-loop insulin delivery system helps make Type 1 diabetes more manageable.
Approved by the FDA in late 2016, this new technology enables direct communication between the continuous glucose monitoring device and insulin pump to stabilize blood glucose at an unprecedented level. The technology replaces the “open loop” concept that requires patients to use information from their continuous glucose monitor to determine how much insulin to inject.
More patients are expected to demand the technology in 2018 as more insurers reimburse for the system. Experts are optimistic that outcomes in patients with Type 1 diabetes will accelerate a similar technology for Type 2 diabetes.
Sleep apnea, the most common sleep disturbance, impacts 21 million Americans and can lead to high blood pressure, heart disease and stroke. While the continuous positive airway pressure (CPAP) device is the gold-standard treatment, more than 40 percent of sleep apnea patients refuse to use it.
Companies are now marketing an implant that delivers stimulation to open key airway muscles during sleep. Controlled by a remote or wearable patch, the technology acts like a pacemaker, helping synchronize air intake with the action of the tongue, using a breathing sensor and a battery-powered stimulation lead. These neuromodulation systems have had positive results in clinical testing and are predicted to deliver a better night’s sleep to more patients and spouses.
In 2018, the FDA is anticipated to approve a new gene therapy for inherited retinal diseases. Delivering a new gene to targeted cells via viral “vectors” is expected to improve vision in some patients with Leber congenital amaurosis and retinitis pigmentosa.
Caused by biallelic RPE65 mutations, these rare genetic conditions cause progressive vision loss and blindness. Currently, there are no FDA-approved treatments. However, an innovative gene therapy delivers a new “normal” working copy of the gene that results in a functional protein. Researchers place this gene inside a modified virus, and this “vector” delivers it to retinal cells.
In 2017, the FDA awarded orphan drug status to RPE65 gene therapy, and a panel of U.S. health advisers recently recommended approval for this innovative approach. Experts believe an approval could lead to orphan drug and breakthrough status for more gene therapies.
Low-density lipoprotein (LDL), or “bad” cholesterol, causes fatty deposits that can clog arteries. With certain new drug combinations, LDL levels are reduced by 75 percent.
New studies have reported a 20 percent reduction in risk of cardiovascular death, myocardial infarction or stroke for patients who take statins combined with a new class of cholesterol-lowering drugs (PCSK9 inhibitors) to reach ultra-low LDL levels.
With over 400,000 coronary disease deaths annually and 102 million Americans living with high cholesterol, these new strategies could turn the tide in 2018.
Removing geographic barriers to care can result in timelier, more efficient and more optimal outcomes as well as significant cost savings. Distance health technologies (or “telehealth”) can enable care for both the physically challenged and those most vulnerable to infection.
Due to an increase in mobile technology and consumer demand, hospitals are getting ready for widespread adoption in 2018. Reportedly, 90 percent of healthcare executives have or are building a telehealth program. Reports predict 7 million patient users in 2018, a 19-fold increase from 2013.
In addition, more patients are now equipped with attachable devices that record and report medical information to doctors to monitor their condition. Over 19 million patients are projected to use these remote monitoring devices in 2018.
With momentum building, experts believe that the emergence and acceleration of distance health technologies and services are assured in 2018.
Developing one vaccine is estimated to cost $200 million and take at least 10 years. With recent Ebola and Zika outbreaks, it’s clear that the process needs to be expedited to curtail an epidemic.
In 2018, innovators will be upgrading the entire vaccine infrastructure to develop new vaccines more rapidly and break ground on novel mechanisms to better deliver vaccines to vast populations.
For example, innovators are perfecting freeze-drying vaccines to allow shipment to more remote locations. Companies are finding faster ways to develop flu vaccines using tobacco plants, insects and nanoparticles. Oral, edible and mucosally delivered vaccines, intranasal vaccines, and vaccine chips are being developed. In 2018, a bandage-sized patch for flu vaccine is expected to be on the market.
These new ways of developing, shipping, storing and vaccinating are anticipated to help stave off current and future diseases and epidemics.
In 2018, targeted therapies will be used more widely to treat breast cancer, a disease that kills more than 40,000 American women per year. A variety of new targeted treatments — such as PARP inhibitors for patients with specific BRCA1 or BRCA2 mutations, and novel CDK 4/6 inhibitors for ER-Positive/HER-2-negative breast cancer — are having positive outcomes in clinical trials.
In addition, novel HER-2 targeted agents continue to show benefits in a subgroup of HER-2-positive patients.
Experts believe that the cumulative results of these studies point to an increasing survival rate, and perhaps the eventual end of chemotherapy for a significant number of breast cancer patients.
For decades, the pre- and post-surgery routine has been standard for nearly all procedures: No eating before surgery; use pain medications for comfort; and stay in bed during recovery. However, due to increasing hospital readmissions and a surging opioid epidemic, innovators are overhauling post-surgery strategies — and delivering impressive results, including ultra-low readmission rates.
Recent research indicates that an Enhanced Recovery After Surgery (ERAS) protocol — which permits patients to eat before surgery, limits opioids by prescribing alternate medications, and encourages regular walking — reduces complication rates and speeds recovery. It can reduce blood clots, nausea, infection, muscle atrophy, hospital stay and more. Patients also are given a post-operative nutrition plan to accelerate recovery, and physicians are using multi-modal analgesia, limiting the use of narcotics.
In 2017, surgical societies and large healthcare systems collaborated to drive funding and education for hospitals looking to implement the protocols on a larger scale.
Hospitals have long struggled with “alarm fatigue,” when busy caregivers become desensitized to the constant noise of cardiac telemetry monitoring systems. Important warning signs can be missed in the din of nuisance pings. Reports indicate that up to 44 percent of inpatient cardiac arrests are not detected appropriately. Consequently, fewer than one in four patients survive an in-hospital cardiac arrest according to the American Heart Association.
Centralized monitoring has emerged as the answer. Off-site personnel use advanced equipment, including sensors and high-definition cameras, to monitor blood pressure, heart rate, respiration, pulse oximetry and more. Complex data are assimilated to trigger on-site intervention when appropriate while filtering out many unimportant alarms.
In 2016, one study reported a 93 percent survival rate of cardiopulmonary arrests among patients for whom a centralized monitoring unit gave advance warnings.
Since then, further innovation has yielded a system that can double the number of monitored patients per technician, improve clinical outcomes, and decrease communication transit times. The results of the “eye in the sky” approach are capturing the attention and imaginations of hospitals around the world.
The practice of “scalp cooling,” which reduces the temperature of the scalp a few degrees immediately before, during and after chemotherapy, has been shown to be highly effective in preserving hair in women receiving chemotherapy for early-stage breast cancer. The scalp cooling system was approved by the FDA in May 2017.
Learn more about this year’s Medical Innovation Summit here.
For more about the top 10 innovations for 2018, see Cleveland Clinic Innovations.
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