To hedge my bets a little, I have included in this list those significant developments that will likely affect the lives of many people over those that are primarily scientific technological advances. For example, the new cholesterol guidelines may not win anyone a Nobel prize, but they sure are going to influence the health care of millions of people all over the world.
Here then are my top choices for the most notable health stories of 2001.
1. Mapping Out The Human Genome. In February 2001, Celera Genomics, a Rockville, Maryland, biotech company, and the publicly-funded International Human Genome Sequencing Consortium, announced the completion of separate maps of the human genome, the entirety of our genetic material. Celera’s was published in the Feb. 16, 2001 issue of Science, the consortium’s in the Feb. 15, 2001 issue of Nature. The mapping of the human genome was the subject of this column on Feb. 27, 2001.
Map is the common metaphor, but what really has been created is a vast database. It means that the full power of computers can be brought to bear in figuring out the genetic origins of disease or how drugs might be tailored to individuals. Some day, a computer chip with your genes on it may be more valuable to your doctor than any medical chart.
Already some scientists are saying that the genome was just a first step, and the real breakthroughs will come with the mastery of the human proteome, the totality of all human proteins. Eric Lander, a prominent MIT geneticist and a leader of the consortium, has compared the genome map to a parts list for a Boeing 777 plane without the tools or instructions to put them together. But it is expected that these tools and instructions to put them together. But it is expected that these tools and instructions will come in due time. And when they do, it will result in a profound transformation in health and medical care.
2. Cholesterol Guidelines Set New Targets. As discussed in this column last week, the US National Cholesterol Education Program (NCEP) overhauled its guidelines for the first time in eight years. Among the noteworthy changes is the recommendation that every adult should get a full lipid profile – which measures total, LDL, HDL, cholesterol, as well as triglycerides – every five years.
Too much LDL ("bad") cholesterol remains the major concern. The new guidelines stress an LDL level of 100 mg/dL as the "optimal" target for people at high risk for heart attack. And while diet and exercise aren’t dismissed, the guidelines say "most people with coronary heart disease will need LDL-lowering drug therapy" to reach the 100 mg/dL mark. Everyone with diabetes or several other conditions (peripheral arterial disease, abdominal aortic aneurysm, symptomatic carotid artery disease) is now considered to be in the high heart-attack risk group. That means they, too, are likely to need an LDL-lowering prescription, probably a statin drug.
3. Walking Away From Diabetes. As the number of diabetics increases, so do data showing that it’s a disease that can be prevented. In the Sept. 13, 2001 issue of the New England Journal of Medicine, Harvard researchers published an analysis of the Nurses’ Health Study data which showed that the single most important predictor of diabetes was being overweight. Lack of exercise and poor diet were two of several other key risk factors. Two large studies of people with impaired glucose tolerance, a prediabetic condition, came to similar conclusions.
In most of these studies, moderate physical activity like walking was critical to the preventive intervention. Dutch researcher Klaas Westerterp published a brief report in the March 29, 2001 issue of Nature that helps explain why. He measured his study subjects’ overall energy expenditure with motion sensors. Then he looked at what kind of activities they engaged in. Surprisingly, the people with the highest energy expenditures weren’t devotees of high-intensity workouts. Instead, they walked, cycled, and engaged in other moderate activities for longer periods of time. Westerterp’s theory: Higher intensity but shorter duration exercises lead to much lower activity at other times, which leads to less overall energy expenditure.
4. A Pill For Cancer. Word about Gleevec ( imatinib ) started to leak out in 2000 yet. It was then known by its pre-market name, STI 571. But in 2001, the cancer drug sprung into the headlines. Remarkably good clinical trial results for patients with chronic myeloid leukemia (CML) were published in the April 5, 2001 issue of the New England Journal of Medicine. A month later, it rocketed through the FDA approval process – a record time for a cancer drug. I reported on Gleevec in an article entitled "New hope in new cancer treatments," published in this column last Nov. 20, 2001.
Cancer specialists are excited about Gleevec for several reasons. It has shown good results in patients who were out of options and likely to die. It is an oral drug with relatively mild side effects – optimists have visions of cancer being managed with a few pills, like other medical conditions. Finally, because it is based on blocking the consequences of a particular genetic anomaly, Gleevec’s success validates the huge scientific investment in understanding the genetic and molecular origins of cancer.
5. Pain Control A Necessity. In an article written in this column last Oct. 30, 2001, I reported on the new emerging attitude among medical practitioners and health facilities that significant pain should no longer be tolerated and that people have the right to choose a pain-free, comfortable existence if they want to.
In the past year, pain management has truly become a recognized medical priority. For instance, new practice guidelines now require that pain be treated as a fifth vital sign – after temperature, heart rate, blood pressure and respiratory rate. Likewise in 2001, the California legislature approved a bill that will make pain management classes mandatory for physicians and require the California Medical Association to discipline doctors who fail to treat pain properly.
All these developments are finally a realization that people don’t have to suffer; that patients can take narcotics for a long time without becoming addicted or having the drugs lose their effectiveness. And doctors now have an extensive pain management arsenal that can control even the most severe pain. Indeed, no one need no longer suffer needlessly!
6. Coping With The Threat Of Bioterrorism. Before the anthrax-tainted letters, bioterrorism existed largely in the realm of pulp fiction or B-movies. A few might have a dim recollection of the Rajneeshee cult in Oregon in the 1970s contaminating salad bars with salmonella. Memories might be fresher of the fear that Iraq was going to use biological weapons during the Persian Gulf war or of the sarin gas attack in a subway in Tokyo in 1995, which wasn’t bioterrorism but showed it was possible to unleash a poisonous agent on unsuspecitng civilians. Now, bioterrorism is neither bad fiction nor something that couldn’t happen here.
In addition to anthrax, bioterrorism experts are concerned about smallpox, plague, botulism, tularemia, and viral hemorrhagic fevers (such as Ebola). More aspects of this phenomenon will be discussed in a forthcoming article in this column. Meanwhile, bioterrorism has arrived on the world scene and it has become another health problem that we should be genuinely concerned about.
Once again, bioterrorism has shown that like cloning and stem cell research, developments in the medical field have the potential to be used for purposes other than what they were originally intended. Scientific advances may indeed be utilized for good or evil. Let us hope that in 2002 and beyond, there would be a greater awareness and realization that new medical discoveries not only have scientific, political and legal implications – but more importantly, bioethical and moral dimensions as well. When that happens, it would be the top health story of the year!