Your A to Z Guide to the Year in Medicine
By David Bjerklie, Alice Park and Sora Song
ATKINS DIET This was the year the naysayers in the medical establishment got high-cholesterol egg on their faces. For three decades, the experts railed against Dr. Robert Atkins and his popular steak-heavy, high-fat, low-carb nutrition plan. Then came surprising new studies showing that the diet not only works (pound for pound, up to 100% better than low-fat diets) but also appears to be good for the heart, lowering triglycerides and raising HDL, the "good" cholesterol. Studies were small, however, and the results preliminary. The last word will probably have to wait for the big five-year, $2.5 million clinical trial, sponsored by the National Institutes of Health (NIH), that is tracking the health effects of the Atkins diet on 360 obese Americans. Meanwhile, the bottom line hasn't changed: you lose weight only when you burn more calories than you eat. (See E for Exercise.)
AIDS It was another bleak year for AIDS, as a U.N. report on the global AIDS epidemic made painfully clear. Among its findings: 40 million people are infected with HIV, 3 million of them children. All told, more than 20 million have died of AIDS since 1981. Progress in the research labs has been slow and not that steady, but it has produced some results. Scientists discovered three proteins--alpha-defensins 1, 2 and 3--that may account for the so-called non-progressors, the 1% or 2% of people who contract HIV but never develop AIDS. Also, the Food and Drug Administration (FDA) approved a new rapid HIV test called OraQuick, which reliably detects HIV antibodies in a blood sample in less than 30 minutes.
ASPIRIN For a little white pill that costs pennies, aspirin may be the closest thing we will ever find to a wonder drug. Not only does it relieve headaches, ease the pain of arthritis and thin the blood to ward off strokes and heart attacks, but as we learned last year, it may also protect against cancers of the pancreas, colon and prostate and even forestall Alzheimer's disease. Unfortunately, we also learned that aspirin isn't a wonder drug for everyone: some 30% of Americans are aspirin resistant and may need either higher doses or a different drug altogether.
BOTOX
2002 was the year of the Botox party--a festive variation on the Tupperware klatch--in which women gather for tea sandwiches and a shot of diluted botulinum toxin in the face. The FDA last year approved the use of Botox, which creates a temporary and localized paralysis in facial muscles, for smoothing wrinkles between the eyebrows. But doctors are also using the shots for such "off-label" applications as crow's-feet, furrowed brows and other frown lines. If the sight of all those glassy Botoxed faces is giving you a headache, get this: researchers at Wake Forest University found that Botox also staves off migraines in sufferers who can't get relief from other drugs. Expect more Botox approvals.
BREAST CANCER Things were confusing enough for breast-cancer patients, but in one regard doctors now have clarity: a lumpectomy followed by radiation, it has been definitively shown, is just as effective as a full mastectomy. Doctors and patients had long been concerned that simply removing a tumor instead of an entire breast might increase the chances of a relapse. But two studies, both published in the New England Journal of Medicine, that followed more than 2,500 women for at least 20 years found no difference in survival rates between those who had had mastectomies and those who had chosen the less drastic lumpectomy with radiation.
BYPASS SURGERY Doctors called it "pump head"--the mental decline suffered by 30% of heart-bypass patients in the days and weeks following their operations. The theory was that their difficulties in thinking, remembering and paying attention were somehow caused by the heart-lung machines that oxygenate and circulate blood during surgery while the heart is stopped. However, a Dutch study last year found no long-term differences in cognitive decline between heart-lung-machine patients and "off-pump" patients, whose hearts were never stopped.
CATARACTS Cataract operations have become routine--3 million are performed in the U.S. each year--but they are not perfect. In too many cases, the performance of the implanted lens is marred by imperfections caused by measurement errors or variations in the healing process. Solution: an implantable lens that can be recalibrated weeks after surgery. The new lens contains a photosensitive compound that is activated by a tiny beam of ultraviolet light, allowing doctors to fine-tune the power of the lens after it's in place. The lens is expected to be commercially available in Europe within the year. Look for it in the U.S. by 2007.
CLONING While Dolly the sheep settles into old age (and prematurely advanced arthritis), scientists continue to churn out carbon copies of cows, pigs, mice, goats, cats and maybe even humans. Last year saw not only the birth of a cloned calico cat called cc (the sole survivor of 87 embryos) but also the widely publicized claim by a bizarre sect called the Raelians that it had created the first human clone--a baby called Eve, born the day after Christmas. Experts have called for DNA testing to prove the baby is a clone, but the child's mother--whose identity and location have been kept secret--have so far refused.
C-REACTIVE PROTEIN You still have to count your cholesterol, but the latest thing your doctor is watching is your CRP level. C-reactive protein is a blood chemical that provides a good measure of the degree of inflammation in your heart vessels. New studies have provided the strongest evidence yet that inflammation is a better predictor than cholesterol levels of your risk of heart disease. What won't change is your doctor's advice. CRP levels are lowered in the same ways by which cholesterol is reduced: diet, exercise and statins.
DIABETES Close to 20 million Americans have diabetes, and nearly that many have a condition doctors have started to call prediabetes. Experts project that by the end of the decade, 10% of the U.S. will be diabetic. A big part of the problem is that cases of Type 2 diabetes, which used to be called adult-onset diabetes, are exploding among children and young adults. For kids at risk, drinking more milk might help. A study found that because the lactose in dairy products metabolizes slowly, it can help regulate blood-sugar levels. This doesn't mean kids should live on milk shakes and fried mozzarella sticks. They need milk, but they also also need to exercise, maintain a healthy weight and eat a high-fiber diet.
DEFIBRILLATOR If you suffer a cardiac arrest, your only chance of survival is to have your heart shocked back into operation within minutes. That's why portable defibrillators are popping up everywhere, notably on airplanes, and why the FDA last year approved the first household version, called the HeartStart Home Defibrillator. It isn't cheap ($2,295), and you can't use it on yourself. Because 70% of cardiac arrests occur at home, perhaps that's where the HeartStart should be.
EXERCISE What's a couch potato to think? First, researchers told us that even a 30-minute walk in the park a few times a week was enough to get the bulk of the cardiovascular benefit of exercise. Then other studies argued that intense activity was much better. Now the government has weighed in with new guidelines that call for an hour of exercise daily--double the previous recommendation. It's enough to make you throw up your hands and look for the TV remote. Don't. The message may be mixed, but it's really very simple: doing anything is always better than doing nothing. And doing more is even better. It's a lesson Americans seem to have missed; 25% get no regular exercise at all.
FETAL HEARTS In a surgical first, doctors fixed a deadly heart-valve defect in a 5-month-old fetus. Guided by ultrasound, they angled a needle-thin catheter into the aortic valve, a spot one-eighth of an inch in diameter in a beating heart the size of a grape. A minuscule balloon was then inflated to enlarge the constricted valve, which had been obstructing the flow of blood to the body. Eleven weeks later, doctors induced early labor, anticipating the need for another operation, but the repair job had worked so well that the 5-lb. 8-oz. healthy baby boy didn't require a second procedure.
FRENCH FRIES Cooking potatoes and other starchy foods at high temperatures can trigger the formation of acrylamide, a compound that has been shown to cause cancer in lab rats. Scientists also know there are toxic consequences to breathing the acrylamide in cigarette smoke. So are chips and fries even worse for us than we thought or just the latest food fright? A report by the American Council on Science and Health concludes that we can relax. There is no evidence that acrylamide, when consumed in food, poses a cancer risk. But all the other reasons for going easy on deep-fried food still apply.
GENE THERAPY When French doctors reported that they had successfully treated four boys for the devastating immune-system disorder known as bubble-boy disease, the news was hailed as the first clear victory for gene therapy. The researchers overcame their patients' genetic deficit by inserting a working version of a gene that enabled the boys to produce healthy infection-fighting cells. But only five months later, similar trials were halted in France and the U.S. when the experimental treatment was blamed for causing a leukemia-like illness in one child. It may be that retroviruses, used to ferry new genes into a patient's DNA, are triggering cancer by interfering with other genes. For now, the promise of gene therapy remains on hold.
HERBS The multimillion-dollar herbal-remedy market took a hit when new studies questioned the efficacy of two of its top sellers. A six-week trial of ginkgo biloba, used to enhance memory, found that ginkgo was no better than a placebo at improving memory, learning or concentration. St.-John's-wort, which is supposed to lift your mood, didn't fare much better in a trial sponsored by the NIH. It concluded that a placebo was as effective as the herb for the treatment of moderately severe depression. (See Dr. Andrew Weil's rebuttal earlier in this issue.) A separate study found that St.-John's-wort interferes with the effects of irinotecan, a widely prescribed chemotherapy drug.
HORMONE-REPLACEMENT THERAPY For millions of women of a certain age, the news struck like a hot flash. A huge, federally funded study of hormone-replacement therapy (HRT) involving more than 16,000 women was abruptly halted when researchers discovered that long-term use of estrogen and progestin was not lowering the risk of heart disease and stroke in postmenopausal women, as had been promised, but raising it, along with the risk of invasive breast cancer and blood clots. What women taking hormones to treat acute symptoms of menopause should do now is unclear. The study showed that there are real risks from long-term hormone replacement, but it didn't say anything about going on HRT for a few years to get over the most acute symptoms of menopause. HRT is still the best treatment available for relief of night sweats, hot flashes and mood swings, and for many women the benefits of short-term treatment will continue to outweigh any uncertainty about the risks.
HYPERACTIVITY Nobody knows what causes the impulsiveness and fidgetiness of attention-deficit/hyperactivity disorder (ADHD), but a brain-imaging study provided further evidence that the disorder is biologically hard-wired. A federally funded 10-year study of nearly 300 children ages 4 to 19 found that the brains of kids diagnosed with ADHD were 3% to 4% smaller in volume than those of normal children. While smaller brains don't necessarily mean lower IQs, brain size does appear to affect the severity of ADHD. In general, the smaller the brain, the greater the symptoms.
INFERTILITY It has been 25 years--and a million births--since the arrival of Louise Joy Brown, the world's first test-tube baby, and you would think doctors would know by now if the procedure carried any extra risks. But only last year studies showed that babies conceived through in-vitro fertilization were more than twice as likely as naturally conceived babies to suffer major birth defects and nearly three times as likely to be born small, a significant risk factor for later cardiac and cognitive problems. It's doubtful either finding will deter many would-be parents who cannot conceive in the usual way.
KNEE SURGERY Arthroscopic knee surgery has been a popular treatment for people whose knees are racked by osteoarthritis. Minimally invasive, it flushes out debris in the joint and smooths bone surfaces without major surgery. But a surprising study showed that the operation is no more effective than a placebo. One in three patients reported improvement, whether having had real surgery or a sham operation with all the same pre-and post-op procedures but no actual treatment. Even if the placebo benefit is ignored, the study still casts doubt on surgery that succeeds only one-third of the time. Patients may be better off doing strengthening exercises and taking off a few pounds to ease the burden on their aching knees.
MAMMOGRAPHY For two years, a bitter argument has raged over medical advice that most women thought was unimpeachable: routine mammograms save lives. The contrarians insist that the statistics don't bear this out. They also argue that mammograms miss 10% to 15% of breast cancers and that the vast majority of the abnormalities mammograms do spot are benign, which results in millions of unnecessary biopsies and countless anxious women. In a sharp repudiation of the critics, Health and Human Services Secretary Tommy Thompson declared that while mammograms are not perfect, they are "an important and effective tool that helps to save lives." The last word, for now.
MERCURY You may not be into heavy-metal music, but if you are a fish eater, heavy metals are inside you. The omega-3 fatty acids in big, deep-ocean fish are good for the heart, but the flesh of fish at the top of the pelagic food chain also tends to be laced with pollutants. Chief among them: mercury, which can increase the risk of heart disease. Should you fish or cut bait? So far it's a draw, with two major studies coming to opposite conclusions. Until more studies are completed, doctors believe that the benefits of fish outweigh the risks, except for pregnant women and nursing moms, who should avoid swordfish and shark to protect their babies from mercury exposure.
NICOTINE You can't smoke 'em if you got 'em in more and more public places, but what about licking 'em or drinking 'em? Not without the government's green light. The FDA warned pharmacists to stop mixing up nicotine-laden lollipops and lip balm, both of which the agency ruled were illegal drugs that could appeal to children. A few months later, the FDA dried up a California company's plans to douse the nation with nicotine water. The only nicotine products the agency okayed for over-the-counter sale were nicotine lozenges, which hit stores in November.
OSTEOPOROSIS Bone may look hard and static, but it's very much alive: new bone cells are constantly being made and old bone cells destroyed. With age, however, less bone gets made than destroyed. Result: 10 million Americans have dangerously low bone mass, or osteoporosis. This process can be reversed, however, and in November the FDA approved Forteo, the first treatment that does that. The drug contains part of the human parathyroid hormone, which builds up bone by boosting bone-making cells and suppressing bone destroyers. Studies show that postmenopausal women taking Forteo along with calcium and vitamin-D supplements significantly reduced their risk of fractures. Unfortunately, Forteo comes only in injectable form, which means daily shots in the thigh or abdomen.
PROSTATE CANCER Watchful waiting has become a byword for prostate-cancer patients, most of whom won't need aggressive surgery to remove their slow-growing tumors. But doctors have long felt uneasy about the tightrope they walked, trying to find the right balance between advising surgery for those men most likely to survive the cancer and counseling those with the slowest-growing tumors to watch and wait. Fresh guidance came last year from a large Scandinavian study, in which men randomly assigned to undergo surgery reduced by 50% their risk of dying from prostate cancer or having their cancer spread. It's not clear, however, how this applies to American men. In the Scandinavian group, most patients were found to have relatively advanced tumors, big enough to be felt in a doctor's manual exam. By contrast, in the U.S., 75% of men's tumors are discovered by a blood test, which picks up cancers long before they become noticeable.
SMALLPOX The rise of terrorism and the anthrax attacks of 2001 have led to concern that this historic scourge, banished from the U.S. in 1949, could be reintroduced into the population. That's why the U.S. government has begun vaccinating military and health-care personnel and ordered up enough vaccine to inoculate the entire U.S. population if necessary. It's the first smallpox-vaccination program since routine shots were discontinued in the U.S. in 1972. Should you get a smallpox shot when it becomes widely available next year, assuming the threat is still merely theoretical? Things to consider before you line up for a shot: many of the college students who volunteered to test the new vaccine experienced fevers, chills and muscle aches severe enough to keep them from classes for a day. Those with weakened immune systems, such as AIDS patients and cancer patients undergoing chemotherapy, as well as people with a history of eczema or other skin conditions probably shouldn't get vaccinated under any circumstances.
STEM CELLS If 2001 was the year of the embryonic stem cell, 2002 was the adult stem cell's turn. When President Bush stopped government funding for the creation of new stem-cell lines from embryos, researchers turned their attention to the next best thing--stem cells extracted from adult sources like bone marrow. Exactly how useful these adult cells will be for therapeutic purposes is a matter of intense debate. A Minnesota scientist reported that she was able to coax bone-marrow stem cells to act like embryonic stem cells, which in theory can give rise to any of the 200 cell types in the body. Other scientists fear that the apparent breakthrough may have been the result of laboratory contamination: in order to get the marrow cells to develop into other cell types, they needed to be mixed with embryonic stem cells.
TAMOXIFEN Most women treated for breast cancer take tamoxifen to prevent the cancer from recurring, but it seems that for the drug to be most effective, timing is key. Until last year, most women with early-stage, estrogen-sensitive breast cancer had surgery followed by chemotherapy and tamoxifen. Tamoxifen blocks estrogen's cancer-promoting effects, but it turns out that the drug keeps chemotherapy agents from penetrating cancer cells and destroying them. An eight-year study of breast-cancer patients showed that women who waited to take tamoxifen until after their chemotherapy cycles were complete were 18% more likely to survive without a recurrence of cancer than women who took the two treatments together.
VACCINES Why is autism 10 times as prevalent among young children today as it was in the 1980s? Many parents, noting that the onset of symptoms coincided with their child's vaccination against measles, mumps and rubella (MMR), are convinced that the mercury used as a preservative in the vaccine is to blame. But doctors have not been able to find a link, and now the results of a Danish survey of more than 500,000 children should finally put the theory to rest. The researchers found no difference in the incidence of autism between children who received MMR shots and those who did not. The more likely reasons for the increase: a broader definition of autism and greater awareness of its symptoms among doctors and parents.
WEST NILE VIRUS Carried by birds on the wing, the West Nile virus continued its westward flight across the U.S. in 2002, killing more than 200 people in the largest outbreak of West Nile encephalitis in the world. Mosquitoes have been infecting birds and following them on their seasonal migration paths to 40 states. Even more worrisome, doctors learned for the first time that the virus can be passed from an infected mother to her unborn child. A girl born in November with brain abnormalities was the first in the U.S. to acquire West Nile encephalitis through intrauterine transmission.
XENOTRANSPLANTS Nobody likes the idea of taking organs from another species and putting them in people, a procedure known as xenotransplantation. But human organs are scarce, and pigs' body parts are similar in size and physiology to humans'. Researchers have even found a way to make pig organs less piglike (and thus less likely to be rejected by human immune systems): by removing one of the genes responsible for the most severe form of rejection. That doesn't mean that pig-to-human transplants are about to begin. The gene is probably one of several that trigger the human immune response, so the genetically engineered pigs are the first in what will probably be several generations of human-friendly porkers.
ZOLOFT For 5% of menstruating women, their time of the month can be particularly exhausting, both emotionally and physically. Those who suffer from premenstrual dysphoric disorder (PMDD), a severe form of PMS, are often debilitated by feelings of sadness and changes in their sleeping and eating habits. Now there's help. The FDA has approved a popular antidepressant, Zoloft, for treatment of PMDD. It works by keeping brain nerves bathed in the chemical serotonin. And unlike other PMDD treatments, such as hormones or psychotherapy, it has been studied in depth in clinical trials.