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Posts Tagged ‘nobel prize in medicine’

Medical science has grown ( and growing )  in an  astonishing pace. Many of the  inventions  which were  considered as  major break throughs   have fallen on the wayside over the years . Of course ,  quite a few  withstood the test of time .

One of  the great inventions  of last century  is per-cutaneous interventions  inside the human coronary artery .

The concept was first conceived and executed by Andreas  Gruentzig  of  Germany in year 1977.  Now , at-least a  million PCIs  are done every year to tackle  CAD  with greatly  improved knowledge base, evidence ,  hardware,  techniques and expertise .

PTCA  is  an  invention worth a Nobel prize . . .well , that’s what we cardiologists feel. The Nobel committee  seems to think otherwise .

What could  be the reasons ?

  1. PTCA is  simply an extension of an old invention. Already the  inventors  of the  cadiac catheterization were  conferred with  Nobel prize (Forssman, Cournand,Richards)  . Hence , it is a sort of duplication of  invention . If Gruentzig is conferred a Nobel prize  the man who discovered the  coronary  stent (A plaque scaffolding device)  will  argue he too deserve  a  Nobel !
  2. What Gruentzig  did  was  in-fact a fundamental  human  response  by Instinct !  .When you encounter  a mechanical obstruction on the road   just try to overcome it . “Here is an obstruction impeding the blood flow , let  me  remove it”  . He did this  with  a wire and balloon . There is not much intellectual  innovation . It was  delivery of a mechanical force through a wire  .   But what the  Nobel  committee should take it to account is , he did this  in live human beating heart  and  cured of his illness most dramatically avoiding a need for surgery.
  3. Finally  comes the vital question. What is the impact of this invention in the health of mankind. ? How  many lives have been  saved when compared to other modalities to treat the   coronary artery disease ? *.This again is not convincingly answered  especially in    stable angina  , for which Geuentzig  originally developed this modality  . One popular argument  is , in terms of life saved and sufferings  relived oral rehydration  fluid  or penicillin  would beat PTCA most convincingly !

* Another possible reason is ,  the  Nobel medical committee is probably well aware of the  perennial  controversy  about  role of  Medicine vs Surgery vs PCI on the outcome   CAD  and  the  superiority of one over the other !

Final message

Whatever  be the reasoning  ,  Nobel committee has to  rethink .  Cardiologists  all over the world   would definitely  agree  if one man who have  made a  huge difference in their patient’s  life ,  it must be  Gruentzig  .

It is well-known  Nobel prize  is given  for path breaking  research that  break  new grounds like  decoding  cosmic mysteries ,  expansion of universe  , cell signalling ,  molecular mimicry  and the  stuff  like that .

Still ,  Gruentzig  definitely  deserves  a Nobel  solely  for  the novelty  in his  procedure  and in the process it helped  avoid  surgery in vast majority of heart patients.

Reference

http://www.nobelprizemedicine.org/

http://circ.ahajournals.org/content/93/9/1621.full

http://www.nobelprize.org/

Video

http://www.angioplasty.org/video/aghero.ram

http://www.angioplasty.org/video/agcomplex.ram

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In any field  , errors and mistakes  transform into   experience in retrospect. (Of course only  if we  realize  our mistakes !) . Many would argue prevention of such errors is the  only way to move  forward in science  , but ,the opposite could also be true.

In Medicine ,

  • Most errors are mild ,
  • Some errors  can   be fatal but it helps us prevent further fatalities.
  • Some errors create history  and  re-define the science.

That’s   what  happened on 1958 , to be precise on  October  3oth , 1958  in a lonely laboratory of Henry  Ford hospital/Cleveland clinic *

*A correction -This  invention actually happened in Cleveland.  ( Sones learnt  all his techniques in Henry ford)

When  Sones along  with his assistant were trying  to do an  Aortogram in a patient with RHD,  the entire dye meant for aorta went straight  into  the right coronary artery.When every one was stunned ,the  patient happily  survived the injection  with a few skipped beats.

The man behind  this horrendous medical mistake was   Mr . Sones . He   was guilty for many days ,  spent many sleepless nights  ( In spite of  the patient surviving  the episode ). In fact , he was much amused  about the patient’s  survival . At that point of time,  even a spill over of dye into coronary artery was considered forbidden.  He pondered over the incident for months  .

Had  two queries  lingering in his mind .

  1. How the  right coronary artery  was able to withstand the 40cc dye  injected with  force .
  2. If 40 m l was tolerated ,  well what about routinely injecting  3-5 ml for visualizing the coronary  tree   by intentionally  seeking the coronary ostium .

That was the moment , the concept of diagnostic coronary  angiogram  was born . He published his observation as an  abstract in Circulation journal. Later he did many experiments  with video  engineering at Kodak labs , X  ray  technology to improve the cine imaging .By 1964 , he devised a perfect protocol  for doing  selective coronary angiogram. Then along with Rene Favaloro he pioneered CABG surgery in USA.

Final message

Cardiac  catheterisation was invented by  Forssman , Cournand , and Richards ,(Nobel prize 1956 ). It was  Sones who took it into the coronary arteries  and thus it was  made possible  for a whole new specialty  of coronary  diagnostics  and therapeutic PCI  which was  conceptualized by another extraordinary human life called   Gruentzig. Sones along with Gruentzig definitely deserve a Nobel in medicine which i think will happen soon ! They lived a great life constantly thinking, innovating  putting  patients interest in the fore front .

Mean while , I argue our youngsters  to  portray  the images of  these giants in  every   cath lab they  work   .You may get their blessings from heaven  , provided you do your interventions with integrity and honesty without any conflict of interest in the patient care.

Do not cry foul when some genuine errors happen in cath lab.Few among us (like Sones ) may innovate those mistakes into glory !

Reference

http://en.wikipedia.org/wiki/F._Mason_Sones#cite_note-3

http://www.wired.com/thisdayintech/2009/10/1030first-coronary-angiogram/

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