Major breakthroughs of medicine in the last 20 years?

[Marco Masi]

We hear so often of the great advances of medicine. Every day one reads of breakthroughs in research in the news. But then I never hear of it again. I'm not a doctor or biologist, but am wondering what are the important discoveries ***and which had practical applications*** of the last 20 years? Can someone cite shortly some...? Thanks.

 

[Ygggdrasil]

Here are some that come off of the top of my head. Not sure all of these fall completely within the 20 year window:

Discoveries with practical applications:
Discovery that HPV causes cervical cancer --> vaccine for HPV (subject of part of the 2008 Nobel Prize in Physiology or Medicine https://www.nobelprize.org/nobel_prizes/medicine/laureates/2008/press.html)

Invention of combination therapies for HIV infection (HAART, highly active anti-retroviral therapy). While the invention of AZT in the 1980s provided the first therapies for AIDS, development of more drugs in the 1990s, especially new classes of drugs like protease inhibitors, allowed combination therapies to come onto the market that were much more effective at preventing drug resistance. While it's not yet a cure, it has helped turn HIV from a death sentence to a manageable condition. In general, the response to HIV is one of the best examples of science relatively quickly coming to solve a major health crisis.

The development of gleevec (imatinib), one of the first targeted therapies against cancer, which has greatly increased the survival of many CML patients.

Discoveries which may have practical applications coming soon:
Cancer immunotherapy -- boosting or engineering the body's immune system to help fight cancer.

CRISPR -- a tool to more easily edit DNA. Currently in trials for a number of applications, including cancer immunotherapy.

Next-generation DNA sequencing -- Advancements in DNA sequencing technology over the past 20 years have brought the price of DNA sequencing to near the goal of $1k per genome, allowing use as a diagnostic tool. No killer applications yet, but plenty of potential.

 

[Evo]

As for drugs, many times the research is announced, then it has to undergo years of testing, possible changes and waiting for approval. If it does get approval, there is no telling in what form or name it will be sold under.

 

[Bystander]

Stroke recovery/rehabilitation.

 

[Choppy]

Interesting question. I'll try to respond from my point of view as a medical physicist. Although, as I try to do this, I feel as if there is a lot to miss so I couldn't ever really do it justice

Over the last 20 years I think we've seen tremendous development and refinement of technologies that were in their infancy two decades ago. Much has been driven by the advancement and increased networking and computing capacity of computers.

In radiation oncology...

1. IMRT and VMAT. This technology gives us the capacity to modulate the intensity of a radiation beam to conform the majority of the radiation to a specific target volume. Coupled with image guidance techniques, it has allowed for effective cancer treatments with fewer side-effects.
2. Image guidance. When patients are receiving radiation therapy knowing where the cancer is and putting the radiation there is critical. In the mid nineties, maybe you would take a film (remember film?) of the patient while set up. Therapists would have to develop the film while the patient lay in wait for treatment, just to make sure everything was lined up. By the mid-to-late 2000s treatment units were coming out with cone-beam CT scans so that a patient could be scanned and a 3D image that could be automatically registered with a treatment plan. Moving forward, I think we're on the cusp of a transition towards MRI-based planning which in principle will make the cancer a lot easier to see.
3. Proton therapy. I put this on my list because of it's conceptual promise. Protons can essentially come to a full stop inside a patient at a point determined by their incident energy - again allowing for a more tailored dose. There has been a lot of investment in this technology in the recent decades, but whether the cost-benefit ratio is justified is still an open question.
4. SBRT or SABR. Stereotactic body radiotherapy or stereotactic ablative radiation therapy - largely enabled by the image guidance and intensity modulation techniques above, is putting much higher doses of radiation into patients in far fewer treatments. There's been a lot of interest in using SABR as an alternative to surgery for early stage lung cancer, since it's been show to be just as effective as a treatment and doesn't involve having one's chest cut open

In imaging...

1. MRI field strength is increasing. I'm not sure what strength of MRI was most the 90s. But today the 1.5T machines are being replaced with 3.0T and the experimental ones are 7.0T. Increasing the field strength leads to higher quality images.
   
2. Combined modality imaging like PET-CT or PET-MRI. Different imaging modalities have different advantages or disadvantages To get the best of both worlds you have to combine them. This has been enabled by the fusion of these machines either physically, or to a lesser extent through advances in image registration techniques. Backing up a little further, the DICOM imaging standard was established in the 90s (there were some efforts prior I believe) that allowed different imaging devices to talk to each other. I think that standard is an easily overlooked achievement in its own right.
3. Machine learning and computer assisted diagnosis. I think this is another one where we're on the cusp of big changes. IBM has a lot of investment in Watson's ability to do this. I'm not sure we're "there yet" but it's a real interesting field.

One advancement that I feel is huge, but also unrecognized is the trend towards industrial and human factors engineering in medicine. In the last decade or so it's come to light that medical errors are a huge source of problems - leading to deaths and complications that are largely preventable by improving processes.

 

[rootone]

Last 20 years?
Accurate DNA mapping?

 

[atyy]

You can find some by looking at the Lasker Awards - the clinical awards are for breakthroughs that have made it into practice. As with most breakthroughs, there are usually many more involved than they give prizes for, but the writeups give some insight into the history.

http://www.laskerfoundation.org/awards/show/deep-brain-stimulation-for-parkinsons-disease/

http://www.laskerfoundation.org/awa...eted-treatments-for-chronic-myeloid-leukemia/ (Ygggdrasil mentioned this in his post #2 above)

http://www.laskerfoundation.org/awards/show/unleashing-immune-system-combat-cancer/

http://www.laskerfoundation.org/awards/show/hepatitis-c-replicon-system-and-drug-development/

 

[mfb]

Proton therapy. I put this on my list because of it's conceptual promise. Protons can essentially come to a full stop inside a patient at a point determined by their incident energy - again allowing for a more tailored dose. There has been a lot of investment in this technology in the recent decades, but whether the cost-benefit ratio is justified is still an open question.

Protons and heavier ions like carbon and oxygen. After initial tests, we now have centers dedicated to this therapy, and while it is not cheap it seems to work quite well so far.

 

[atyy]

Proton therapy. I put this on my list because of it's conceptual promise. Protons can essentially come to a full stop inside a patient at a point determined by their incident energy - again allowing for a more tailored dose. There has been a lot of investment in this technology in the recent decades, but whether the cost-benefit ratio is justified is still an open question.

Is this the one where the parents kidnapped their kid so he could have the therapy?

http://www.bbc.com/news/uk-england-32013634

 

[Ryan_m_b]

Monoclonal antibody therapy for cancer and autoimmune diseases are a little bit older than 20 years but have seen huge development during that time.

As a general note: media will always report medical advances as "major breakthroughs" because it sells papers. In reality its very rare for a completely new form of medicine to be developed and implemented leading to drastically increased survival rates/quality of life. It's a lot less dramatic but the history of medical research is a slow, painful slog of incremental developments. If you compare survival rates of things like cancer over time you'll see a gradual increase year on year, a testament to the millions of man-hours of research. But you won't often find a dramatic shift due to some eureka moment, that's just not how science generally works.

 

[Dr. Courtney]

Joint replacement technologies.

 

[Dr. Courtney]

Considering the diabetes epidemic (first world problem), I'd also rate the inexpensive and widely available blood glucose monitors as well as the array of prevention and treatment options as a major breakthrough of the past 20 years. Lab screenings for A1C are vastly improved and more accurate, and there are even at home, instant, A1C monitors available on the shelves at Walmart.

 

[Ygggdrasil]

http://www.laskerfoundation.org/awards/show/hepatitis-c-replicon-system-and-drug-development/

The story of the anti-hepatitis C drugs (e.g. Sovaldi) illustrates @Evo's and @Ryan_m_b's points about the delay between breakthrough and application. Hepatitis C Virus (HCV) was first isolated in 1989, but it took until the late 1990s for researchers to develop methods to work with the virus in the lab. These methods allowed scientists to begin testing drugs, and the lead compound that would eventually become Sovaldi was invented in 2005. However, it would take nine more years for the drug to hit the market (in 2014) as scientists needed to tweak aspects of the drug's structure to improve its stability in the body and get it through clinical trials.

 

[nrqed]

We hear so often of the great advances of medicine. Every day one reads of breakthroughs in research in the news. But then I never hear of it again. I'm not a doctor or biologist, but am wondering what are the important discoveries ***and which had practical applications*** of the last 20 years? Can someone cite shortly some...? Thanks.

Functional MRI

 

[russ_watters]

AIDS drugs.

 

[jackwhirl]

 

[berkeman]

Stroke recovery/rehabilitation.

Yeah, advances in thrombolytic therapies have made a big improvement in ischemic stroke outcomes Great stuff...

http://www.neurology.org/content/79/13_Supplement_1/S119.full.pdf

 

[strangerep]

Genetic recombination techniques to synthesize important proteins.

E.g., synthesis of blood clotting factors (e.g., "Benefix") for treatment of haemophilia (which once relied on extraction of the factors from human blood, and hence risked infection by other viruses, and indeed killed many haemophiliacs via aids).

 

[tech99]

Important discoveries seem to have resulted from epidemiology and the consequential public health consequences of people making simple changes. For instance, the improvements in rates of cancer and heart attack resulting from the messages about smoking, alcohol, diet and exercise.

 

[John d Marano]

Transcranial magnetic stimulation https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation is allowing researchers to decipher how the brain works in great detial

 

[HWPratt]

Think about this: you don't hear the phrase "exploratory laparotomy" (abdominal surgery to look and see what's going on) anymore.

When I was a resident there was a procedure called a ventriculogram in which air would be injected into the ventricles of the brain and the patient would be placed in a chair that would swivel in 3 different axes so that X-rays could (sort of) determine the shape of the ventricles as the air bubbles moved around -- this was to detect brain tumors. It gave the patient's vicious headaches that lasted 3-4 days. Now there is CT and MRI.

Of course that was more than 20 years ago.

 

[atyy]

http://www.nejm.org/doi/full/10.1056/NEJMoa1513257
Targeting BCL2 with Venetoclax in Relapsed Chronic Lymphocytic Leukemia

Treatments for cancer founded in the basic science of 20-30 years ago are now seeing some success.

 

[kimster1]

Wow! "Ventriculogram"! You're really dating yourself! Here's one for you - I once participated in performing a "lymphangiigram". We inserted the smallest gauge needle available - probably a 25g - into tiny lymph branches between the toes. Then over a matter of about 3-5 hours we injected radiographic dye and intermittently took x-rays [emoji15]. CT scanning made that diagnostic test obsolete!

 

[Tsu]

Think about this: you don't hear the phrase "exploratory laparotomy" (abdominal surgery to look and see what's going on) anymore.

When I was a resident there was a procedure called a ventriculogram in which air would be injected into the ventricles of the brain and the patient would be placed in a chair that would swivel in 3 different axes so that X-rays could (sort of) determine the shape of the ventricles as the air bubbles moved around -- this was to detect brain tumors. It gave the patient's vicious headaches that lasted 3-4 days. Now there is CT and MRI.

Of course that was more than 20 years ago.

You mean a pneumoencephalogram. I did those when I was a radiology student. They were gruesome! Ventriculograms are of the heart ventricles.

 

[Tsu]

And it was WAY more than 20 years ago. ;) (I'm showing my age here... :0) And yes...CT did away with exploratory laps in the '80's.

 

[Tsu]

Wow! "Ventriculogram"! You're really dating yourself! Here's one for you - I once participated in performing a "lymphangiigram". We inserted the smallest gauge needle available - probably a 25g - into tiny lymph branches between the toes. Then over a matter of about 3-5 hours we injected radiographic dye and intermittently took x-rays [emoji15]. CT scanning made that diagnostic test obsolete!

WOW! Lymphangiograms! I HATED doing those! When will we do away with hysterosalpingiograms and voiding cystos?!? :)