Larry Davis, photographed at Big Bear Lake in August 2011. After nearly losing his hands in a blaze, the former fire captain is again able to do what he loves best: fishing.

Fire Captain Larry Davis had spent his life helping people in need. But after a horrific blaze devastated his hands, he faced a lifetime of limitations—until a dedicated surgeon reopened his world.

Past the spiked and sculpted Joshua trees, the lazy stretches of sagebrush, and the front yard with the cow and her inquisitive calf, sits the house that Larry Davis built.

He built it back in 1991, when this high-desert community of Apple Valley was beginning to boom. He did all the plumbing and tile work, built the fences, assisted with the framing. He and a buddy did the electrical work. Over 11 months, he hammered, drilled, painted, and sanded, shaping the structure with his hands until the beige-and white ranch house was ready to be called home.

“A lot of what you see here I built myself,” he says firmly.

Inside the house, Larry, 49, leads the way to the dining room table. Six feet tall, with the strong build of the football linebacker he once was, he brings a glass of water and deftly slaps an errant fly with a bright green fly swatter.

Carrying a glass, swatting a fly—most of us take such simple tasks with our hands for granted. At one time, Larry did, too.

The fire changed everything.

The same year that Larry built his house, another dream came true: He became a full-time firefighter.

Originally, he had followed in his uncle’s footsteps as a plumber. But he had also moonlighted as an on-call fireman for Apple Valley. With the town opening three new fire stations, he jumped at the chance to go full time.

It was a perfect fit. He was young and strong. He had played football in high school and community college, and he liked being part of a team. Most importantly, he liked helping people.

“I didn’t think of it as being a hero,” Larry explains. “But I enjoyed all that came with fighting fire and just helping people in need, people who are facing a true emergency.”

What ideas are shaping tomorrow’s medicine?

What are the coming innovations in treating heart disease and cancer?

What is the latest thinking in genetics and regenerative medicine?

From the minds of our scientists and clinicians, we bring you 10 noteworthy, thought-provoking ideas that have the potential to transform medicine.

1. Time-Traveling Cells

Imagine you have been diagnosed with a heart problem. Your cardiologist must choose among 10 different medications. Some might help, but may also cause side effects. Fortunately, you have banked your own line of powerful stem cells. Developed from your own blood cells, stem cells can become any tissue, including lung, eye, muscle, or brain. Your cardiologist asks the laboratory to grow heart cells from your own stem cells. A few days later, your heart cells begin beating—in a petri dish. Now the 10 medications are applied to the cells. The process reveals which medication will work best for you, with a lowered risk of serious side effects.

“This is a technique that I think in less than 50 years will be routine,” predicts Clive Svendsen, PhD, a pioneer of stem cell science and director of the Cedars-Sinai Regenerative Medicine Institute (RMI). “Every patient at Cedars-Sinai could have their own pluripotent stem cell line banked in a repository.” It would be personalized medicine at its finest, and Dr. Svendsen sees Cedars-Sinai playing a pivotal role in developing the technology.

The key is the induced pluripotent stem (iPS) cell: a blank-slate human cell created by pushing ordinary adult cells “back in time” to an embryonic state. These extraordinary cells are expanding regenerative medicine, a rapidly developing field that seeks to understand how your own cells can be made to repair or regrow diseased or malfunctioning organs.

RMI scientists and their peers are already employing iPS technology to create powerful models that may radically change the way we understand Lou Gehrig’s disease, Alzheimer’s, corneal blindness, liver disease, and a host of other ailments. An explosion in discovery of new drug therapies isn’t far behind.

Dr. Svendsen is even using iPS technology to scrutinize that most elusive human condition: aging. “The fact that you can reprogram an 80-year-old cell and make it embryonic has to imply that aging in some sense is reversible,” he says. While there are no guarantees, this may eventually lead to a new understanding of the aging process in cells, why humans age, and how we may prevent it or at least slow it down. As aging is the major risk factor for most human diseases, this could have an enormous impact on medicine. “Pluripotent stem cell therapy is a quiet revolution that is going on in laboratories around the country and the world,” says Dr. Svendsen, “and to me it’s the most exciting area of science right now.” — Sarah Spivack LaRosa

Law student Michael Sharp, 22, photographed in the moot courtroom at Nova Southeastern University, Florida. Six years ago, he couldn’t walk, couldn’t write, and was struggling to stay in school.

Michael Sharp’s apartment is a short walk from the beach, but Michael isn’t much of a beachgoer.

He looks the type: laid-back, low-key, introspective, hair about shoulder length. But the self-described “kind of a geek” would rather play video games—his favorite pastime—than surf or bask in the sun.

Besides, Michael is still self-conscious about the scars on his chest where a battery-powered generator resides—scars he didn’t have six years ago. But then, before his surgery in 2005, he was confined to a bed or wheelchair with his body twisted into painful, uncontrollable contortions.

Unbeknownst to his parents and his doctor, when Michael was born on March 8, 1989, one of his genes wasn’t perfect. There were no outward signs or symptoms, and he and his little sister, Katherine, ran and jumped and grew just like the other kids in his South Florida neighborhood. He played ice hockey and swam on a team.

And then, when he was 11, his right hand started to curl. His teachers were the first to notice that his penmanship was turning into scrawl. His wrist had become fixed in a bent position, pushing his fingertips in and under his hand when writing, aiming the pencil in the wrong direction, at a backward slant.

“I remember my mom telling me I was writing strangely,” Michael recalls. “I would just write crooked. I don’t know how to describe it.”

His mother, Victoria, bought a wrist support, but it was no match for the force seizing Michael’s forearm. As she realized that no amount of physical or mental effort could help her son control his arm and hand, Victoria made appointments with a pediatrician and a neurologist in Ft. Lauderdale. Michael was diagnosed with dystonia, which causes muscles to contract involuntarily, forcing affected body parts into awkward and often painful positions.

Several types of dystonia exist. Michael’s was triggered by that tiny flaw in his genetic code.

From the chance discovery of quinine as a malaria treatment in the 17th century to Alexander Fleming’s accidental encounter with penicillium mold in 1928, some of medicine’s most important advances have occurred through serendipity or error.

Call them happy accidents. Still, inadvertent discoveries would be nothing without keen, creative minds knowing what to do with them. As Louis Pasteur famously said, “In the field of observation, chance favors only the prepared mind.” Here are some legendary accidental breakthroughs in science, and some lesser-known ones that have emerged recently from the prepared minds of Cedars-Sinai researchers.

Peter Barath, MD, was concerned that some patients who had previously undergone procedures to clear blocked coronary arteries were returning months later with a condition called restenosis—renarrowing of the arteries. He believed the problem could be solved by a novel approach to traditional angioplasty: attaching microsurgical blades to the surface of a conventional balloon catheter to induce more controlled incisions—from inside the artery. He began tinkering in the Medical Center’s Laser Lab, slicing off the cutting edges of razors and epoxying those edges to a balloon. The resulting Barath Cutting Balloon was a breakthrough that gave invasive cardiologists a more precise tool that reduced the risk of vessel-wall injury. With healing localized to the incision areas, the amount of scar tissue leading to restenosis was also limited. Today, sales of the Barath Cutting Balloon generate $100 million annually and are still growing. Dr. Barath’s inspiration led to a major advance in interventional cardiology.

When you finish an experiment and the results support your hypothesis, you are probably having a good day in the lab. But when the unexpected happens and you step back, shake your head, and take another puzzled look, GREAT!

Great scientists—those at the tip of the arrow—do not simply repeat and verify others’ work. They create new concepts. These out-of-the-box thinkers see the world differently. When others see mold and say, “We have to cut that out,” the Alexander Flemings of the world say, “But wait! Why are no microorganisms growing there?”

From the “odd observation,” penicillin was born.

Many of the groundbreaking ideas in medicine began in “but wait!” moments. My first encounter with the odd observation phenomenon was in my teens, after I maneuvered my way into the research lab of a prominent Cleveland heart surgeon. I suspected the artificial heart valves of the day were damaging red blood cells, so I got permission to study blood from dogs that had the valves. The next step was practicing with human blood drawn from the heart-lung bypass machine when patients were undergoing open-heart surgery. Because of my school schedule, preparing the blood took more time than I had in any given day. So I would start the process, incubate the cells overnight, and pick up again the next day.

Name: Steven Rad, MD
Chief Resident
Obstetrics and Gynecology

Over the winter holiday of 2010, Steven Rad, MD—a third-year obstetrics and gynecology resident at Cedars-Sinai—traveled 9,300 miles to Mbarara Hospital in Uganda in East Africa. For one week, he and his mentor Dotun Ogunyemi, MD, director of Cedars-Sinai’s Obstetrics and Gynecology residency training program, partnered with their counterparts in Mbarara, seeing patients, conducting rounds, delivering babies, and teaching. The region has Uganda’s highest fertility rate, with an average of seven children per woman, as well as a high infant mortality rate. The symbiotic learning experience that emerged proved so useful that Dr. Rad now facilitates a monthly videoconference between OB/GYN doctors and researchers at Cedars-Sinai and physicians in Mbarara. Though from vastly different worlds, both groups must deal with large numbers of high-risk pregnancies. Technology allows them to collaborate on complex cases and attain a global perspective on women’s health.

The Challenge: Mbarara Hospital serves a population of about eight million people, notes Dr. Rad. “Most women deliver their babies at home in their villages and only go to the hospital when there is a complication. Even so, 10,000 babies are born in Mbarara Hospital each year—almost 3,000 more than at Cedars-Sinai. There is no prenatal care in the region, and the Cesarean rate is as high as 30 percent.”

No Resources, No Problem: According to Dr. Rad, the doctors at Mbarara Hospital handle all pregnancy complications with very limited resources. “We have been learning from them how to do C-sections with very few sutures, how to control bleeding without medications, and how to treat pregnancies coupled with infectious diseases such as malaria or HIV.”

Technology Saves Lives: “The hospital in Mbarara has an ultrasound machine and a cardiotocography machine to monitor the baby’s heart during labor, but the staff didn’t know how to use them until we visited,” says Dr. Rad. They now know how to operate the equipment, but the only resources they have for interpreting the data and images are their textbooks. “That’s not good enough, so we are able to explain to them what certain readings and images mean during our videoconferences. They are still not using the new technology as a standard practice, but we hope to travel there within six months to get it implemented into their medical routine.”

Remote Medicine: Uganda does not have a single maternal-fetal medicine specialist, notes Dr. Rad. “With our monthly videoconference, we are able to give doctors in a remote area of Africa access to specialists at Cedars-Sinai so they don’t have to rely on information on the Internet to solve complex cases.”

For All Women: “If you really believe in being a physician for women, and are passionate and committed to advocating for women and mothers, then you care about women all over the world and not just in the United States. Our residents are learning to have a global health perspective and to treat women and children everywhere—even in areas with little or no resources.”

Education Expansion: Dr. Rad and the team at Cedars-Sinai recently added a teaching hospital in Ghana to their videoconference schedule. “We are also collaborating with maternal-fetal medicine specialists in the United States who are interested in global health,” he says. “Our hope is to expand the number of national and international centers in our field to participate in the videoconferencing.”

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Dr. Gewertz was named vice dean of Academic Affairs and will be responsible for ensuring consistent quality across the center’s academic programs. He will work with Richard Katzman, vice president of Academic Affairs. Dr. Fine will serve as vice dean of Research and Research Graduate Education. Working with Mark Daniel, vice president of the Burns and Allen Research Institute, Dr. Fine will be responsible for the scientific components of research and research training activities.

Dr. Gewertz will maintain his current roles as surgeon-in-chief, chair of Surgery, and vice president for Interventional Services. Dr. Fine will continue as chair of Biomedical Sciences.

* * *

Richard Nathan Bergman, PhD, has been named director of the Cedars-Sinai Diabetes and Obesity Research Institute. Dr. Bergman also joins Cedars-Sinai’s Department of Biomedical Sciences and Department of Medicine as a distinguished research scientist.

Long renowned for his diabetes and obesity research, Dr. Bergman’s achievements include pioneering the use of engineering technology to understand the mechanisms that lead to diabetes. He also developed the “minimal model,” which describes how insulin reacts in the body and has become the standard for determining causes of diabetes.

Dr. Bergman comes to Cedars-Sinai from the University of Southern California, where he served as the Keck Professor of Medicine and chair of the Department of Physiology and Biophysics.

He holds an undergraduate degree in engineering from Case Western Reserve University and a PhD in Physiology from the University of Pittsburgh.

***

Armando Giuliano, MD, executive vice chair of Surgery for Surgical Oncology at Cedars-Sinai, earned the prestigious Susan G. Komen for the Cure® Brinker Award for Scientific Distinction in Clinical Research for 2011. He received the award for his research leading to less invasive surgical treatments for breast cancer, specifically the removal of fewer lymph nodes in certain women with early-stage breast cancer. Dr. Giuliano’s work demonstrated that surgeons can often effectively remove only the sentinel nodes—the first lymph nodes the cancer reaches—rather than conduct more aggressive lymph node removal, thereby reducing complications and side effects. ***

Edwin Posadas, MD, a noted clinician and researcher with expertise in treating advanced prostate cancer, has joined Cedars-Sinai as clinical director of the Genitourinary Medical Oncology Program in the Samuel Oschin Comprehensive Cancer Institute.

Dr. Posadas’ research focuses on the mechanisms through which cancer cells in localized tumors spread to other parts of the body. His laboratory identified the protein FYN as a possible regulator involved in metastasis, the spread of cancer. In upcoming studies at Cedars-Sinai, Dr. Posadas will work to comprehensively define FYN’s function in prostate cancer cells, with the goal of developing new therapies to treat advanced prostate cancer. He brings with him a laboratory funded by a Department of Defense grant.

***

George Berci, MD, FACS, received the 2011 Jacobson Innovation Award, the highest prize bestowed by the American College of Surgeons. The award, given at a dinner held in his honor in Washington, D.C., recognized Dr. Berci for his 50 years of achievements, which include being a pioneer in developing the endoscopic and laparoscopic techniques that are the basis of all minimally invasive surgeries performed today.

Dr. Berci began his surgical career in 1953 in Budapest, where he helped establish one of Europe’s first experimental surgery programs. Dr. Berci’s work led to the diagnostic and therapeutic use of laparoscopes for obstetrics and gynecology specialists and the development of techniques that have enabled surgeons to remove colon polyps without open surgery. For years he has led the field of endoscopic surgery from Cedars-Sinai, where he is senior director of Minimally Invasive Endoscopic Research.

***

Edward Phillips, MD, executive vice chair of Cedars-Sinai’s Department of Surgery, has been elected as a fellow in the American Surgical Association, the nation’s oldest and most prestigious surgical organization.

A leader in minimally invasive surgery, Dr. Phillips is noted for his contributions to advanced laparoscopic techniques. He serves at Cedars-Sinai as director of the Saul and Joyce Brandman Breast Center—a Project of Women’s Guild at the Samuel Oschin Comprehensive Cancer Institute, chief of the Division of General Surgery, director of the Wasserman Breast Cancer Risk Reduction Program at the Samuel Oschin Comprehensive Cancer Institute, director of the Center for Weight Loss, and as a surgeon at the Colorectal Cancer Center of Excellence.

***

James K. Min, MD, an expert in noninvasive cardiac imaging, has joined the Cedars-Sinai Heart Institute as director of Cardiac Imaging Research and co-director of Cardiac Imaging. He also has a joint appointment in the Department of Imaging and the Department of Biomedical Sciences in the Biomedical Research Imaging Institute.

Widely regarded as a preeminent scholar and clinician focused on cardiac imaging, Dr. Min has been the principal investigator in several multicenter trials and has authored more than 100 articles in peer-reviewed medical journals. He is currently president of the Society of Cardiovascular Computed Tomography.

Dr. Min comes to Cedars-Sinai from Weill Cornell Medical College and New York-Presbyterian Hospital in New York City, where he served as director of Cardiac Computed Tomography.

***

Michael Alexander, MD, professor and vice chairman of the Department of Neurosurgery at Cedars-Sinai, is the new president-elect of the Society of Neurointerventional Surgery, an organization of doctors who treat brain aneurysms, strokes, carotid artery blockages, other brain artery disorders, and spinal abnormalities through minimally invasive procedures. Dr. Alexander directs Cedars-Sinai’s Neurovascular Center, one of the largest referral centers on the West Coast.

***

The National Eye Institute has awarded a $3 million grant for Cedars-Sinai stem cell researchers to develop gene therapy in corneal stem cells to alleviate damage that can cause vision loss in diabetes sufferers.

“Diabetes is the leading cause of blindness among working-age adults,” says Alexander V. Ljubimov, PhD, director of the Ophthalmology Research Laboratories at the Regenerative Medicine Institute and principal investigator for the five-year grant.

Cedars-Sinai researchers found that corneal stem cells in diabetics become abnormal when their corneas stop producing certain proteins. The researchers hope to use gene therapy to trigger production of these proteins and restore stem cell functions, spurring normal corneal cell turnover and keeping the tissue healthy and transparent.

Clive Svendsen, PhD, director of the Regenerative Medicine Institute, and Yaron Rabinowitz, MD, chief of Ophthalmology, are co-investigators on the grant.

***

Surgical oncologist and breast cancer researcher Alice Chung, MD, has joined Cedars-Sinai. She previously served as assistant director of the Margie Petersen Breast Center and assistant director of Breast Clinical Research for the Margie & Robert E. Petersen Breast Cancer Research Program at the John Wayne Cancer Institute at Saint John’s Health Center. She is a former Cedars-Sinai resident who received her medical degree from Chicago Medical School and completed her fellowship training at the Memorial Sloan Kettering Cancer Center. Her research interests include outcomes for sentinel node-positive breast cancer patients, preoperative imaging for axillary metastases, breast-conserving surgery in multifocal and multicentric breast cancer, and the impact of magnetic resonance imaging on the treatment of ductal carcinoma in situ.

Michael Lill, MD, leads Cedars-Sinai’s Blood and Marrow Transplant Program. Today, blood and marrow transplant is one of the most aggressive procedures used in the battle against cancer. This technique seeks to replace cancerous cells with transplanted healthy blood, bone marrow, or stem cells. Dr. Lill is himself a cancer survivor. While growing up in Perth, Australia, he got his kicks playing “Australian rules” football, but he now focuses his energy on staying fit with martial arts.

Q. How does your personal experience with cancer influence your work?

A. I had appendix cancer and I think my experience really helps me understand the uncertainty that all of my patients deal with. I have firsthand knowledge of how difficult it is to face the unknowns that surround treatment options and long-term outcomes.

Q. What kind of martial art are you studying?

A. It’s Jeet Kun Do [which literally means “Way of the Intercepting Fist”], a martial arts fighting system that the late actor Bruce Lee developed and used in his films. My dojo combines a free-form mix of martial arts—primarily JKD, which is derived from Kung Fu in style, but also Brazilian Jiu-Jitsu, Thai kickboxing (Muay Thai), and French kickboxing (Savate).

Q. Are you planning to pick a fight with someone?

A. No! (laughs). I haven’t been in a fight since I played football in Australia, but I very much enjoy the physical aspects of life. When you do martial arts, there is a Zen component to the experience. You totally focus on what you’re doing instead of thinking about life-and-death issues or work-related things.

Martial arts are a major source of stress relief for me. I work in a high mortality area and am very often delivering bad news to a patient. It helps to have an outlet that engages all of your mental and physical energies. I could live a week off the endorphins generated in one fighting bout.

Q. You are also doing something very unusual as a caregiver: performing blood-free transplants for Jehovah’s Witnesses, whose religion forbids any medical treatment that uses blood or blood products.

A. Many of my colleagues think I’m slightly crazy to be doing this, and they’re more than happy to refer their Jehovah’s Witness patients to me. We respect their beliefs, and we minimize the wastage of blood through extraneous blood tests. We should probably apply these principles more widely in the health profession.

Q. What moved you to do this for your patients?

A. In my capacity as a healer, I am not a technician. We’re supposed to be treating the whole human being. And that involves an understanding of their spiritual side as well as the mechanical, technical aspects of deciding what dose of chemotherapy to give.