* Cleveland Clinic compiles annual list of top innovations
* Bariatric surgery tops list for controlling diabetes
* Headache device, skin cancer scanner also on list
By Debra Sherman
Oct 31 The best medical innovations for next
year include an almond-size device implanted in the mouth to
relieve severe headaches and a handheld scanner resembling a
blow dryer that detects skin cancer, the Cleveland Clinic said
The clinic's annual list of the best medical innovations for
2013 includes better mammography technology and new drugs to
treat advanced prostate cancer.
Leading the 2013 list for innovations is an old procedure
that has a new use due to findings in a recent study. Physicians
and researchers at the clinic voted weight-loss surgery as the
top medical innovation, not for its effectiveness in reducing
obesity, but for its ability to control Type 2 diabetes, the
most common form of the disease.
Over the years, bariatric surgeons noticed that the
procedure would often rid obese patients of Type 2 diabetes
before they even left the hospital.
Dr. Philip Schauer, head of the Cleveland Clinic's Bariatric
and Metabolic Institute, led a study examining this phenomenon,
and the prestigious New England Journal of Medicine published
the results earlier this year.
"Bariatric surgery has been around for a while," Cleveland
Clinic Chief Wellness Officer Dr. Michael Roizen said in an
interview. "The reason it was chosen as the top innovation is
because Medicare has broadened its indication for payment, and
Medicaid in many states follows Medicare. A lot of the other
(private) insurance companies started covering it, so it's much
The criteria that insurers use to cover the surgery has been
broadened because of its effectiveness in controlling Type 2
diabetes, he said.
The number of people affected by diabetes has tripled over
the past 30 years to more than 20 million Americans, according
to the Centers for Disease Control and Prevention. More than 90
percent of those cases are Type 2, a condition in which the body
does not produce enough insulin or the cells ignore the insulin.
Doctors and researchers at the Cleveland Clinic voted for
what they thought were the biggest, most significant innovations
from the 250 ideas submitted from their colleagues. Roizen said
one of the main criteria for getting on the list is the number
of people that the product or procedure can potentially help.
For that reason, a device that helps relieve headaches, the
second-most common ailment after the cold, was second on the
The miniaturized device - invented at the Cleveland Clinic
and spun off into a separate, private company called Autonomic
Technologies Inc - is implanted in the upper gum above the
second molar to treat cluster and migraine headaches. A lead tip
of the implant is placed near specific nerves behind the bridge
of the nose.
When the patient feels the headache coming on, a remote
control device is placed on the outside of the cheek, and the
device delivers stimulation to those nerves, blocking pain.
The implant is available in Europe, but not in the United
States. The company needs to do more studies to get approval
from the U.S. Food and Drug Administration, said Dr. Frank
Papay, department chair of the clinic's Dermatology and Plastic
Surgery Institute and a consultant to Autonomic Technologies.
A handheld device used to detect melanoma, the most deadly
form of skin cancer, was also on the list.
"Up until now, we've counted on our eyes," Dr. Allison
Vidimos, who chairs the clinic's dermatology department, told
Reuters. "This device offers an objective look underneath the
skin using a special spectrum of light."
It compares moles and other marks on the patient's skin with
a large database containing information on all types of
melanoma. It also rates the risk.
"All dermatologists fear missing melanomas," Vidimos said.
"The cure rate can be close to 100 percent if caught early."
Vidimos said using a device, manufactured by Mela Sciences
Inc and approved by FDA last year for use by trained
dermatologists, helped prevent unnecessary biopsies. The Mela
scanner is also approved in Europe.
Verisante Technology Inc also makes a scanning
device, which is approved in Canada, Europe and Australia. It
has applied for U.S. approval, the company said.
Also on the list is a new type of mammography, called breast
tomosynthesis. This technology provides greater detail of the
image than the standard mammography, which renders a
For the patient, it may seem like there's no difference.
"You still have the squish," said Dr. Alice Rim, the Cleveland
Clinic's section head of diagnostic radiology. But the images
produced by the new technology show the breast in slices, for
more visible detail.
"With two-dimensional mammography, there are shadows, so it
can be like a polar bear running around in a snowstorm," Rim
said. "This eliminates the shadows, allowing increased detection
and fewer call backs (for a second mammography)."
Other devices that made the list include mass spectrometry
that allows microbiology laboratories to identify the type of
bacteria in infections sooner and with more specificity, a new
modular stent graft to treat complex aortic aneurysms, and a
laser for cataract surgery.
Novel drugs to treat advanced prostate cancer were on the
clinic's list because of their ability to halt the progress of
the disease by blocking testosterone receptors.
A new technique to repair and regenerate damaged lungs,
called ex vivo lung perfusion, is on the list. Experts say as
many as 40 percent of previously rejected donor lungs may now be
suitable for transplantation after undergoing this novel "lung
The procedure involves placing donor lungs into a
bubble-like chamber connected to a cardiopulmonary pump and
ventilator. Over four to six hours, the lungs are repaired as
special fluids are forced through the blood vessels. Nutrients
are used to recondition the lungs as they inflate and deflate.
The final item on the list is neither a procedure, a drug
nor a device, but healthcare programs that use incentives to
encourage people to take better care of themselves.
For example, the Medicare Better Health Rewards Program Act
of 2012 provides incentive payments to Medicare participants who
voluntarily establish and maintain better health.
"We are seeing efforts to avoid rationing of healthcare and
seeing programs with incentives built in if people maintain
their health," Roizen said. "This can radically change the cost
"We're seeing this more in big companies, the GE's and
J&J's of the world. All companies are looking at how much they
are spending on healthcare, and they are looking at ways they
can reduce spending without rationing."