My Favorite Innovation
The X-ray machine, the flu vaccine, anesthesia—not so long ago, these medical standards heralded paradigm shifts in the way we manage disease. Investigators continue to improve quality of life with new techniques, devices, and drugs for maladies big and small. Here, Cedars-Sinai clinicians laud their favorite innovations in medical history, from the unsung and established to the experimental and cutting edge.
Illustration: Isabel Espanol
Daniel Berman, MD
Director, Nuclear Cardiology/Cardiac Imaging
Aspirin is way up there! Known for over a century to reduce fever and inflammation, aspirin has now been shown to prevent heart attacks. Even more, aspirin’s anti-inflammatory properties act on chronic diseases in many different organ systems beyond the heart—but we are just learning about those.
IN VITRO FERTILIZATION
Margareta Pisarska, MD
Director, Division of Reproductive Endocrinology and Infertility
In vitro fertilization (IVF) has revolutionized our ability to help women become pregnant and couples start families. We can harvest an egg, allow fertilization to happen outside of the reproductive tract, and transfer it into a woman’s uterus. IVF has made it possible for 6.5 million babies to be born since 1978. It is critical for single people who freeze their eggs for future use, and for those diagnosed with cancer at a young age, because cancer treatments can impact fertility. No words can describe the joy when patients tell us they’re ready to deliver after successful IVF treatments.
THE CLOT BUSTER
Patrick Lyden, MD
Chair, Department of Neurology Director, Cedars-Sinai Comprehensive Stroke Center Carmen and Louis Warschaw Chair in Neurology
My favorite medical innovation is a drug that dissolves blood clots—in particular in the arteries that supply the heart, brain, or lungs. It works a little bit like Drano: Pour it down your clogged drain and it churns and bubbles and the drain clears. The first clot buster was very powerful, but it wasn’t safe. Twenty years later, along with several other investigators, I used a safer drug based on a natural enzyme to clear stroke-causing blood clots in the brain. Now we have even better ways to open blocked arteries, but using enzymes to do it was groundbreaking, and proof that brains, hearts, and lungs could be saved.
Neel Joshi, MD
Clinical Chief, Department of Surgery
My favorite innovation—the one that has made the greatest impact in my career and also had a huge societal impact—is laparoscopic surgery. Fifty years ago, when someone had appendicitis or gallstones, we had to make a very large incision through the skin and muscles and tissue in the abdominal wall to remove the diseased organ. The aftermath of the incision could be almost as serious as the condition being treated. Today we’re able to perform the same major surgeries in a minimally invasive manner, with very tiny incisions the width of a pinky finger. Most surgeries I do are outpatient, which leaves patients less traumatized and with smaller scars and faster recovery.
Alexandra Gangi, MD
Surgeon, Samuel Oschin Comprehensive Cancer Institute
Anesthesia has not only made surgery much more humane, but it’s also allowed surgeons to make many advances. Historical accounts suggest that patients would be given a shot of vodka and a hunk of wood to bite down on—how stressful that must have been! Without modern anesthesia, it’s unlikely that patients would agree to most elective procedures knowing they’d have to endure such pain and agony. I have a hard time believing we’d come up with any of the laparoscopic, robotic, or catheter-based procedures we perform today if our patients couldn’t tolerate them.
Celine Riera, PhD
Assistant Professor, Sports Spectacular Diabetes and Obesity Research Center CRISPR/Cas9 is a very exciting invention. Its genome-editing capabilities allow us to modify pretty much any gene. A recent CRISPR advance now lets us modify multiple genes simultaneously, giving us capabilities unheard of five years ago. It’s a totally amazing tool.
Debiao Li, PhD
Director, Biomedical Imaging Research Institute Karl Storz Chair in Minimally Invasive Surgery in honor of Dr. George Berci
As an engineer, I see imaging as one of the most important medical technologies of the last century. It’s had so much impact on how we diagnose disease. Just 30 years ago, you could only diagnose based upon symptoms, a blood test, and maybe an electrocardiogram—which meant a lot of patients might get misdiagnosed. With imaging, we can make a much more accurate diagnosis in most fields of medicine. In addition, imaging is powerful for looking at patient response so we can find out early on if a treatment is effective.
Julia Ljubimova, MD, PhD
Director, Nanomedicine Research Center in the Maxine Dunitz Neurosurgical Institute A groundbreaking recent discovery for cancer treatments, especially brain tumors, is immunotherapy. We are able to fight the disease at inception with highly targeted attacks. Understanding the disease on a molecular level also could prove to work with neurological degenerative disorders such as Alzheimer’s, as the mechanisms may be similar.
Keith Black, MD
Chair, Department of Neurosurgery Director, Maxine Dunitz Neurosurgical Institute Ruth and Lawrence Harvey Chair in Neuroscience The discovery of antibiotics—particularly penicillin—was a turning point in medicine. Mortality and longevity were revolutionized—we could give medicine and essentially prevent someone from getting an infection. It really changed our paradigm and felt almost miraculous.
Ali Azizzadeh, MD
Director, Division of Vascular Surgery
In 1894, an assassin stabbed French President Sadi Carnot. The attack tore Carnot’s portal vein—a large blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas, and spleen to the liver. Back then, surgeons didn’t yet know how to suture blood vessels and they weren’t able to save the president’s life. French surgeon Alexis Carrel spent almost 10 years experimenting on animal subjects until he finally used a technique taught to him by a seamstress. Carrel won the Nobel Prize in 1912 for pioneering the ability to operate on blood vessels. His breakthrough would become my favorite innovation: vascular anastomosis—the repair of blood vessels with sutures.
Vaccines George Liu, MD, PhD Director, Infectious and Immunological Diseases Research Center
Vaccines have likely been around since 10th century China. The concept that you can be briefly exposed and then suddenly become immune to a disease is still absolutely stunning. In our lab, we are working on vaccines for MRSA [methicillin-resistant Staphylococcus aureus] and even for acne. Vaccines are the biggest invention the world has ever seen in terms of their effect on everyday people.
Total hip replacement David Thordarson, MD
Director, Orthopedic Research
The total hip replacement is among my favorite medical innovations. In the 1960s, in England, Sir John Charnley developed the total hip replacement and—despite multiple refinements—it was essentially as successful as any hip replacement currently available. It has dramatically improved the quality of life of thousands of patients. Also, due to its huge success, other joints in the body such as the knee, shoulder, and ankle are now replaced using similar principles to the hip replacement developed decades ago.
MRI imaging Zixin Deng
Postdoctoral scientist in Li Laboratory
The MRI scanner enables physicians to visualize the soft tissue and internal structures of the human body to help diagnose various types of disease. The images are not just used to visualize 3-D volumetric and time-resolved structural changes; they can also be used to evaluate functional information, visualize and quantify blood flow, and characterize tissue properties. Ongoing research has been looking at new imaging biomarkers to help achieve better diagnosis and improve patient outcomes. The technology opened the door for many medical fields to achieve better patient diagnostics, and it’s continuously improving to achieve better patient comfort and more accurate diagnoses.
Checkpoint inhibitors Hyung Kim, MD
Director, Academic Urology Program
Co-Medical Director, Urologic Oncology Center
Associate Director, Surgical Research, Samuel Oschin Comprehensive Cancer Institute
Associate Director, Urology Residency Training Program
Homer and Gloria Harvey Family Chair in Urologic Oncology in honor of Stuart Friedman, MD
My first job in 2005 was working on accelerating the immune system to fight cancer as a more targeted alternative to chemotherapy. For 30 years, medicine had been looking for ways to step on the gas of our immune system. Most approaches were unsuccessful when applied to patients, and those were some discouraging times. I remember asking my mentors if it was time to shift gears and pursue a different line of research, but their advice was to keep working on tumor immunology even though it wasn’t necessarily in vogue. I took that to heart and persisted, and cancer immunotherapy is now considered exciting.
What has changed is that we learned to simulate an immune response against cancer through use of drugs classified as checkpoint inhibitors. In my lab, we are currently studying metabolic triggers to help T cells (a type of immune cell) recognize and “remember” tumor cells. The hope is to help patients generate long-term immunity against cancer. These approaches could potentially enhance the activity of checkpoint inhibitor medications.