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The Top 10 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
• The first decade of the
21st Century brought a
number of discoveries,
mistakes, and medical
advances that have
influenced medicine
from the patient's
bedside to the medicine
cabinet.
WHAT IS NEW IN THE LAST DECADE
DR.T.V.RAO MD 2
MAPPING THE HUMAN GENOME ADVANCES
MEDICINE
• Mapping the human genome had become a race
of time and money in the 1990s, with two
competitors at the forefront: the government-
funded Human Genome Project, which
completed its task in 15 years with more than $3
billion in taxpayer money, and a private
company, Celera Genomics, which was financed
with $100 million and took less than a decade.
DR.T.V.RAO MD 3
• " The biggest area of
the future will be
preventive medicine,".
"By understanding the
genetic causes and
links to disease we can
spend more and more
attention on preventing
disease."
GENOMIC SCIENCE ADVANCES PREVENTIVE
MEDICINE
DR.T.V.RAO MD 4
• In 2003 a "final" draft
was released by
researchers, and in
2007 more updates
to the genome were
published by Craig
Venter, PhD, chief
scientist behind
Celera Genomics.
A CRAIG VENTER PUBLISHES THE
FINAL DRAFT
DR.T.V.RAO MD 5
• Doctors have
developed a genetic
test for a gene
associated with
prostate cancer, "and
there's a drug available
that greatly lowers the
risk for prostate cancer
in the future."
GENETIC ASSOCIATION WITH PROSTATIC
CANCER DECODED
DR.T.V.RAO MD 6
• Doctors say the Internet
and information technology
has actually changed the
way they practice medicine
for the better. Even doctors
need to look things up from
time to time.
• With a pad and pen, then
sit in the waiting room while
the nurse pulls their file.
INFORMATION TECHNOLOGY TO
PATIENTS AND DOCTORS
DR.T.V.RAO MD 7
• In the past if you had a clinical
question to research, I had to go
to the library, pull out multiple
years of the Index Medicus, look
up the topic, write down the
references, go to the stacks and
pull the volumes of journals, find
the article, read the article, go to
the copy machine and make a
copy& if I were lucky, I would
have my answer in about four
hours.
• Now you have everything
at your finger tips
THE KNOWLEDGE AT YOU FINGER TIPS
DR.T.V.RAO MD 8
• Now You can be on rounds and
in five minutes have more
information on the topic than I
need& on my iPod Touch or iPad
I can look up a medication, check
the formulary to see if it's
covered, check for interactions
with a patient's other meds and
double-check details of the
pharmacology of the med plus
quickly review the problem I am
treating, and You don't even
have to go online
YOUR IPOD TOUCH OR IPAD BRINGS
EVERYTHING ….
DR.T.V.RAO MD 9
• Information technology
has also, to some
degree, made life safer
for the patient. Once
admitted to a hospital,
they get a bar code
which matches their
blood samples and their
IVs.
INFORMATION TECHNOLOGY MAKES
LIFE SAFE
DR.T.V.RAO MD 10
• But many physicians have
been reluctant to go digital
because there is a
significant upfront
investment, which is why
several of the healthcare
reform measures now
before Congress include
provisions to underwrite
some of this cost.
• The developing countries
should go a long way ?
INFORMATION TECHNOLOGY SHOULD BE
SUPPORTED BY THE HOSPITALS ???
DR.T.V.RAO MD 11
• In a report issued last
October, the Institute of
Medicine said those
public smoking bans
have cut exposure to
second-hand smoke,
which, in turn, has
contributed to a
reduction in heart
attacks and death from
heart disease.
ANTI-SMOKING LAWS AND CAMPAIGNS REDUCE
PUBLIC SMOKING - YES
DR.T.V.RAO MD 12
• Anti-smoking campaigns (at least
in the U.S.), including banning of
smoking in workplaces and
public places, [have] enormous
impact across socioeconomic
classes on many diseases
• In terms of the greatest
good for the greatest
number, there can be no
doubt that the decline in
smoking (through various
means) has had the
greatest impact
ANTISMOKING LAWS HAVE IMPACT
ON SMOKING
DR.T.V.RAO MD 13
• It's probably the
most important
'doable' public
health measure
for decreasing
morbidity and
mortality,
ANTISMOKING LAW REDUCES
MORBIDITY AND MORTALITY
DR.T.V.RAO MD 14
• Those looking for dramatic improvements in public health need look no further than the world of heart disease.
• A mere 25 years ago, when a patient came to a hospital with a heart attack, the best that could be done was to put the patient in a darkened room, give him or her morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats, and hope for the best.
HEART DISEASE DEATHS DROP BY
40 PER CENT
DR.T.V.RAO MD 15
• Today treating a heart attack is all about speed: speed the patient to the hospital so that a clot that blocks the life-saving flow of blood can be "busted" with drugs like the genetically engineered tissue plasminogen activator or tPA.
GENETICALLY ENGINEERED DRUGS FOR
RESCUE IN HEART DISEASE
DR.T.V.RAO MD 16
• Moreover, drugs that didn't
exist 25 years ago -- chiefly
statins like simvastatin,
Lipitor, mevacor, and
Crestor -- are now routinely
used to slow the
progression of
atherosclerosis, the
medical term that describes
the build-up of the hard,
waxy substance called
plaque that narrows
arteries.
NEW DRUGS CHANGES THE FUTURE OF
HEART DISEASES
DR.T.V.RAO MD 17
• Research shows
about half of the
gains in heart
disease came from
new treatment
interventions, the
other half (up to 60
percent) are due to
prevention.
PREVENTIVE CARDIOLOGY SOLVES MANY
ISSUES ON HEART DISEASES
DR.T.V.RAO MD 18
• Importantly, what this
means is that the
community 'gets it.'
Better control of blood
pressure, pre-emptive
lowering of blood
cholesterol levels,
better diets, and
reduced smoking are
resulting in fewer
(cardiac) events,
PROMPT SCREENING GREATLY HELPED
MANY PATIENTS
DR.T.V.RAO MD 19
• Probably no area of
research has so fired
the public imagination
and so ignited the fires
of public controversy as
that of stem cell
research. In reality, this
area has generated
more political action
than reproducible
clinical advances
STEM CELL RESEARCH: LABORATORY
BREAKTHROUGHS AND SOME CLINICAL ADVANCES
DR.T.V.RAO MD 20
• European researchers
genetically manipulated
bone marrow cells
taken from two 7-year-
old boys and then
transplanted the altered
cells back into the boys
and apparently arrested
the progress of a fatal
brain disease called
adrenoleukodystropy
GENETIC MANIPULATIONS HAVE CURE FOR
MANY CRITICAL DISEASES
DR.T.V.RAO MD 21
• Now we can make
embryonic-like stem cells
directly from skin cells,
which makes it possible to
model a multitude of human
diseases in the petri dish.
New drugs based on stem
cells are being developed,
and the first human clinical
trial based on products of
human embryonic stem
cells is expected
NOW WE CAN MAKE STEM CELLS TO OUR
NEEDS
DR.T.V.RAO MD 22
• Two blockbuster-targeted
therapies burst on the cancer
scene in late 1990s, and
arguably changed forever the
concept of cancer treatment,
converting what was often a fatal
disease into a chronic illness.
The first, Herceptin, is a drug
that targets a type of breast
cancer that is characterized by a
specific cancer gene -- an
oncogene -- called HER-2.
TARGETED THERAPIES FOR CANCER
EXPAND WITH NEW DRUGS
DR.T.V.RAO MD 23
• Women whose cancers
express HER-2, which
is estimated to be about
25 percept of women
with breast cancer, will
respond to Herceptin
even when other
powerful chemotherapy
drugs have failed.
NEW DRUGS ARE EFFECTIVE IN
CHEMOTHERAPY FAILURES
DR.T.V.RAO MD 24
• The introduction/approval
of trastuzumab (Herceptin)
and lapatinib (TyKerb) in
breast cancer will prevent
many women's breast
cancers from recurring and
have significantly improved
survival for many women
faced with breast cancer.
More important, these
drugs represent highly
effective agents that target
the cancer, not the patient
NEW DRUGS CHANGES THE SOLUTIONS TO
CANCER
DR.T.V.RAO MD 25
• Other drug, a cancer pill
called Gleevec, targets
genetic mutation called
bcr-abl (b.c.r. able) that
causes cancer cells to
grow and multiply in
patients with a variety
of cancers, including
chronic myeloid
leukemia or with a
stomach cancer called
GIST.
NEW DRUGS TARGET GENETIC
MUTATIONS
DR.T.V.RAO MD 26
COMBINATION DRUG THERAPY EXTENDS HIV
SURVIVAL
• Since the introduction of highly active antiretroviral
therapy, or HAART, as this combination therapy
approach is called, HIV/AIDS has evolved into a
serious, but chronic disease with survival stretching
into decades.
• Moreover, this "cocktail" approach to treatment where
drugs are combined in different ways or different
sequences has become a model for treating other
diseases ranging from lung cancer to heart disease.
DR.T.V.RAO MD 27
• The drop in death rates from HIV
in the developed world (is) due to
improved medications, "There
was the 10 per cent drop in
deaths due to HIV in the US
between 2006 and 2007.
• In Africa, where the HIV/AIDS
crisis hits hardest today, doctors
are slowly making progress-and
in some cases real gains, which
is the case with the use of
antiretroviral drugs to block
mother-to-infant HIV
transmission.
BETTER APPROACHES IN
HIV INFECTIONS
DR.T.V.RAO MD 28
• Advances are being
made in the developing
world, with Botswana
leading the way not with
a 3% vertical
transmission rate. It
was the first and still is
the most effective
prevention strategy
DEVELOPING WORLD TOO SHOW PROGRESS
IN REDUCTION OF VERTICAL TRANSMISSION
DR.T.V.RAO MD 29
• Robotic surgery increased the
ability of cancer surgeons to
get clean margins as well due
to the magnification of the
structures
• he greatest benefit of tiny
openings into the body rather
than large incisions made by
traditional surgery, may --
believers say -- be shorter and
less painful recovery time.
MINIMALLY INVASIVE AND ROBOTIC
TECHNIQUES REVOLUTIONIZE SURGERY
DR.T.V.RAO MD 30
STUDY FINDS HEART, CANCER RISK WITH
HORMONE REPLACEMENT THERAPY
• Until July 2002 most doctors treating middle-age women believed that giving their patients hormones -- either oestrogen alone or oestrogen combined with progestin -- would protect their 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, and was considered the best treatment to control the annoying and sometimes disabling symptoms of menopause such as hot flashes, depression, and sleep disturbances
• However research proves otherwise. >
DR.T.V.RAO MD 31
• And then the world
changed, the National
Heart Lung and Blood
Institute, which was
sponsoring a placebo-
controlled trial of hormone
replacement therapy in
more than 161,000 healthy
women, announced that it
was shutting down the
study because HRT
increased the risk of heart
attack, stroke, blood clots,
and breast cancer.
HORMONE TREATMENTS CAN
INCREASE HEART DISEASE RISKS
DR.T.V.RAO MD 32
• Two biggest advances
in breast cancer this
decade was the
targeted-breast cancer
treatment with
Herceptin and "the
finding that
postmenopausal
hormone replacement
is associated with a
huge increase in the
risk of breast cancer."
HORMONE REPLACEMENT TREATMENT
LEADS TO INCREASED RISK OF CANCER
DR.T.V.RAO MD 33
• Mind-reading has moved
from carnival attraction to
the halls of medicine with
what is known as a
functional MRI.
• The medical mind-readers
are not trying to identify a
card randomly selected
from a deck -- they are
using sophisticated imaging
techniques to map the way
the mind works.
SCIENTISTS PEER INTO MIND WITH
FUNCTIONAL MRI
DR.T.V.RAO MD 34
• The process, often called fMRI,
traces the working of neurons --
brain cells -- by tracking changes
in the oxygen levels and blood
flow to the brain. The more brain
activity in one area, the more
oxygen will be used and the
more blood will flow to that area.
The patient lies awake inside an
MRI scanner. He or she is asked
to perform a simple task, like
identifying a colour or solving a
math problem.
A GREATER UNDERSTANDING
WITH MRI
DR.T.V.RAO MD 35
• As the patient answers the
question, the fMRI tracks
the areas of the brain that
are activated by tracing the
speed at which the cells
metabolize the sugar, or
glucose.
• First developed in the early
1990s, fMRI began to
shape research at the
beginning of the decade
FMRI TRACTS REAL-TIME EVENTS ON
FUNCTIONALITY OF BRAIN
DR.T.V.RAO MD 36
• Using this fMRI technique, researchers
are learning valuable
information about
disease such as
depression, brain
cancer, autism, memory
disorders, and even
conditions such as the
skin disorder psoriasis.
BETTER UNDERSTANDING OF SEVERAL
DISEASES WITH F-MRI USAGE
DR.T.V.RAO MD 37
CLONING OF MYCOPLASMA CHANGES THE
PRINCIPLES OF BIOLOGY
DR.T.V.RAO MD 38
DR.T.V.RAO MD 39
• Programme created by Dr.T.V.Rao MD
for Medical and Paramedical
Professionals in the Developing World