DEVELOPMENT AND INNOVATION IN CARDIOVASCULAR MEDICINE - Innovation in the Biopharmaceutical Industry - page 32

greatest cause of mortality and morbidity on a global scale in the decades ahead.
The growing burden of cardiovascular disease linked to obesity and diabetes is the
new and emerging challenge to cardiovascular science.
The rapid advances in science that led to new drugs and technologies have also
created a significant challenge to healthcare providers in delivering effective care for
patients: increased demand for more effective and more widely available medicines
will continue to challenge biomedical science in the future. Should further scientific
advances be considered “a burden” on the health delivery process? Should we seek
to curtail further advances and focus on control of healthcare costs, or should we
encourage future advances, confident that success will bring health and economic
benefits?
How will biomedical science rise to these challenges? In considering this, an
understanding of the way advances have been made in the past and the challenges
ahead is important. This paper will outline some of the major developments that have
emerged over the past century and challenges for the future, using cardiovascular
medicine as an example.
Early Developments
Harvey's understanding of the circulation of the blood was based on detailed anatom-
ical studies and was a key breakthrough of the Enlightenment. Understanding cir-
culatory function in vivo , particularly in man, has always been a challenge due to its
relative inaccessibility. The early physicians developed remarkable clinical skills
for examining the heart and circulation based on close observation, aided by the
stethoscope introduced by Laennec in 1816, the first great technical development
in cardiovascular medicine. The first modern breakthrough for the assessment of
cardiac function was the electrocardiogram (ECG). First recorded in man by Waller
(1887), Einthoven (1895) later established the power of the ECG to reveal impor-
tant aspects of cardiac function. The contributions by Waller and Einthoven are
classic examples of “development” and “innovation” applied to medicine. Waller
demonstrated and published the principle using a mercury capillary electrometer;
Einthoven applied the much more sensitive string galvanometer to collect recordings
of better quality. This innovation opened the way for a wide range of techniques for
diagnosing abnormalities in the heart rhythm as well as its structure and function.
Coronary heart disease is the most frequent cause of death in the developed world
(Murray and Lopez, 1997) and the ECG remains the most widely used technique for
diagnosing it. During the 20th century innovations of the basic ECG have spawned
a wide range of new techniques and treatments. For example, the ability to record
the ECG from within the cardiac chambers using flexible electrodes introduced