By the Harvard Medical School Faculty
The past year has seen a wide variety of health-related headlines — the terrorist threat of smallpox infection, a new caution about hormone replacement for menopausal women, and advances in gene therapy and cardiac care, to name a few. Here are the Harvard Medical School Faculty's picks for the Top Ten health/medical stories of 2002.
1. The Limits Of Hormone-Replacement Therapy
Many women were profoundly affected by the finding that combination estrogen and progesterone therapy (HRT) for menopausal women carried more risks and less long-term benefits than we realized. The flurry of worry created when the study was first released has quieted. It has been replaced with a better understanding of how short-term HRT still can be used to treat menopausal symptoms, while most women should avoid long-term HRT for disease prevention. The jury is still out on estrogen alone and other forms of HRT. — Alice Y. Chang, M.D.
2. Walter Willett's Healthy Eating Pyramid
Substituting carbohydrates for fats isn’t working. Despite fewer fats in our foods, Americans are getting heavier and heavier. New evidence supports changing focus: Limit total calories, exercise every day, eat as many vegetables as you want, use monounsaturated and polyunsaturated oils, and stay away from trans fats and saturated fats. — Howard LeWine, M.D.
3. Smallpox Vaccine
This year marked the 25th anniversary of the global eradication of smallpox as a naturally occurring disease, but also the first year since 1972 that the vaccine was recommended for U.S. civilians. Current plans are to offer vaccination to all adults, starting with health-care and disaster workers. While widespread vaccination is seen as the best pre-emptive defense against a bioterror attack, the vaccine causes significant side effects, and experts expect one to two deaths for every million people vaccinated. — James S. Winshall, M.D.
4. C-Reactive Protein Test Holds Promise In Cholesterol Screening
A simple, inexpensive blood test to measure C-reactive protein (CRP) seems on the verge of becoming a routine screening test to help doctors and patients figure out who has an increased risk of heart disease — and therefore might benefit from use of statin therapy to lower cholesterol. Research in 2002 indicated that CRP levels might be an even better screening test than LDL cholesterol. Some experts recommend holding off on routine CRP testing until ongoing trials prove that treatment of patients with low LDL and high CRP do better with statins, but many physicians are starting to use this test in patients with low LDL levels already. — Thomas H. Lee, M.D.
5. Global Fund To Fight AIDS, TB, And Malaria
The Global Fund to Fight AIDS, Tuberculosis, and Malaria, proposed by United Nations Secretary General Kofi Annan, received $2.1 billion in pledges, and began disbursing funds to assist impoverished countries in overcoming these three diseases of poverty, which together account for nearly 6 million deaths per year. — Serena Koenig, M.D.
6. Increasing Rate Of Type 2 Diabetes In Children
Americans continue to become obese at an alarming rate. With the rise in obesity rates, type 2 diabetes (formerly called adult-onset diabetes or non-insulin-dependent diabetes) is reaching epidemic proportions with younger and younger people being affected. If this trend continues, type 2 diabetes could become more common in children than type 1 diabetes (insulin dependent diabetes). The good news is that we can halt this epidemic by increasing physical activity, including time devoted to daily exercise, and improving our diet. — Howard LeWine, M.D.
7. Diuretics Are Best, Cheapest Treatment For High Blood Pressure
Thiazide type diuretics (chlorthalidone and hydrochlorothiazide) are clearly the drug class of choice when a person needs drug treatment for high blood pressure. Lined up against two of the most popular and much more expensive drugs, thiazides are at least in good in almost all categories and in several categories are better. And the wholesale cost is less than a penny per day. — Howard LeWine, M.D.
8. Drug-Coated Stents Revolutionize Cardiac Care
Sometime early in 2003, many if not most coronary angioplasties throughout the United States will be performed using wire stents coated with drugs that reduce the rate of recurrence of artery narrowings to nearly zero. Many experts believe this innovation will transform care for people with coronary disease, leading to lower risks for heart attacks. Physicians will have a much lower threshold for recommending angioplasty now that its main complication seems destined for the history books. The additional cost — about $2000 per stent. — Thomas H. Lee, M.D.
9. Research Proves Some Alternative Therapies Effective
Scientific research on complementary and alternative medicine is increasingly found in high-profile medical journals. Evidence has emerged suggesting the effectiveness of some therapies, such as saw palmetto for enlarged prostate, ginkgo for some types of dementia or claudication (leg pain caused by artery narrowing), glucosamine for knee osteoarthritis, and garlic for mild cholesterol reduction. Studies continue in these areas, often with financial support from the U.S. National Institutes of Health. There is also rising awareness of dangers of some herbs and supplements, such as possible liver problems from kava, contamination of products such as PC-SPES, and potentially serious drug interactions with St. John's wort.
10. First Successful Gene Therapy For Immune Deficiency
Gene therapy has proved generally disappointing. However, in 2002 a research team successfully accomplished gene therapy in patients with a rare, severe immune system defect caused by mutation in a single gene. The research team extracted stem cells from the patients’ blood, introduced the healthy version of the defective gene into those cells, grew the cells in large numbers outside the body, and then injected them back into the patients, leading to a new immune system without the disease-producing genetic defect – all without any side effect. — Anthony L. Komaroff, M.D.