Doctor offers picks for top medical stories of 2009
Every year brings medical breakthroughs, but some are more likely than others to have a real impact on Canadians' lives.
Dr. Dworkin, a practising family doctor, professor of family medicine at the University of Ottawa and a host on News Talk Radio CFRA in Ottawa offers his top picks for the five biggest health discoveries of the year.
5. The Zamboni theory on MS and the Liberation Treatment
This was a discovery brought to light by CTV's W5 and medical specialist Avis Favaro. This theory contends that multiple sclerosis patients suffer from blockages in the veins in their necks or the azygous vein down their spine that cause blood to reflux back into the brain and leave the deposits of iron that mark MS.
Zamboni has also found that angioplasty to open these clogged veins can lead to remissions in MS symptoms in some patients.
Dworkin notes that the treatment study involved only 65 patients and there is still a lot more to learn.
"What we don't know is whether the MS itself led to the veins being like this or whether the veins themselves contribute to the MS. But what it does is open avenues of understanding of what we call 'the mechanism of disease' or pathophysiology," Dworkin said.
"If it increases our understanding of MS, I think that's fantastic. If it's a treatment for all types of MS - there are four types - that remains to be seen," he said.
4. The use of viruses to fight bacteria
We've long been told that bacteria are learning how to become more resistant to antibiotics. But a study released in April is offering hope for a new avenue of attack.
The study provided the fist clinical trial of a treatment using something called bacteriophages, which are viruses shaped like lunar landers that can infect bacteria.
"It's a virus that lands on the bacterial surface, infects itself into the bacteria, hijacks its genetic machinery and destroys the bacteria," he explained.
Researchers at University College London Ear Institute conducted a study on patients with severe drug-resistant ear infections. After just two weeks of using an ear drop made with bacteriophages, the patients' infections cleared up.
Dworkin says the study offers hope that bacteriophages could be the answer to antibiotic-resistant superbugs.
"We're seeing more and more resistant strains of bacteria and perhaps this might be a way of combating that, given that antibiotics are not working very well anymore for some bacteria and we don't have as many antibiotics being developed," he said.
"So this may be a means of combating that particular problem."
3. Preventing brain cell death in stroke patients
Researchers from Toronto may have achieved a better understanding of how brain cells are killed by a stroke that might lead to new drug treatments to limit brain damage after strokes.
Until now, neuroscientists have thought the major culprit in nerve cell death from strokes is glutamate, an amino acid that carries signals from cell to cell. But researchers have found that therapies that offered antagonists to glutamate receptors didn't work as a treatment for stroke.
So Dr. Michael Tymianski, an associate professor of surgery and physiology at the University of Toronto and his team looked again and found something new. They found that activation of a separate channel called TRPM7 causes production of toxic free radicals that kill brain cells.
"They developed a gene therapy that blocked the protein. And by blocking the protein, they actually preserved the brain cells. It's opening up an understanding of how to treat people after stroke."
The hope is the discovery could produce an effective treatment to save brain cells in the minutes after a stroke.
2. Lasers to stitch wounds closed
This study emerged in February from researchers at Massachusetts General Hospital in Boston, who developed a technique to close wounds nearly instantaneously.
The approach uses laser light and light-activated dye called Rose Bengal that is applied to the edges of the skin. The laser transfers electrons between the dye molecule and collagen in the skin and causes the molecular chains of collagen to chemically bond.
The technique closes the skin just as stitches would but without the risk of infection that sutures can carry. There are then no gaps in the wound and no "railroad" track marks to leave scars.
"The application of this goes beyond just the skin," says Dworkin. "It could be used for attaching nerves that have been severed, tendons, ligaments, limb reattachments. But minimizing the use of sutures, you end up with a better closure and less damage from those sutures."
1. Using gastric bypass surgery to treat type 2 diabetes
This was a story that made headlines in May, after Dr. Richard Stubbs of the University of Otago in Wellington, New Zealand, presented research that found that gastric bypass surgery can cure diabetes -- even before it causes weight loss.
Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine, resulting in fewer calories being absorbed.
While it might be assumed that the resulting weight loss might cause the diabetes in obese patients to go into remission, Stubbs' research suggests something else is going on. His team found that even within six days after the surgery, when weight loss hadn't even yet begun, the patients' diabetes was gone.
Stubbs believes that the explanation as to why the surgery would so quickly cure diabetes is that the portion of the gut that is bypassed in surgery must be producing a hormone that makes the body resist insulin.
"They hope to determine how to block this protein -- they expect in two years to identify it - and thereby find another means of treating diabetes," says Dworkin.
"So it's very interesting because it offers a new understanding into what leads to insulin resistance in type 2 diabetes."