Another "epidemic" – that of obesity – was also in the limelight in 2003. Its importance was highlighted by recent major cover stories in two noted international newsmagazines – "The Shape of Things to Come" in the December 13-19, 2003 issue of The Economist and "Obesity: The World’s Expanding Middle" in the December 15, 2003 issue of Newsweek magazine. Obesity has become a growing concern in the past few years, but research on the subject seemed to have reached a critical mass last year. You can expect that obesity, in one form or another, will be in the list of top health headlines for years to come.
Many of the health stories which landed on the past year’s list were the subjects of my previous columns.
In the end, the virus proved to be less contagious and fatal than feared. And had it not been for Chinese government officials withholding information, it may have never spread very far. Still, there was a real possibility that the epidemic might explode. But using the latest scientific technologies and communicating instantly via the Internet, scientists identified the responsible virus within a few weeks. Its entire genetic sequence was determined, diagnostic tests developed, treatments tested, and vaccine development begun. Meanwhile, old-fashioned public health measures contained SARS and, almost as importantly, fear of it. By any measure, this was a triumph of biomedical science and public health.
Doctors, scientists, and even politicians have learned the hard way to be humble about "beating" diseases. We still don’t have an AIDS vaccine. SARS may well return anytime, but the damage it will cause is likely to be reduced because of the weapons we now have to contain it.
Researchers exploring the causes of obesity confirmed conventional wisdom. Couch potatoes take note: An analysis of the Nurses Health Study data showed that the risk of obesity increased 23 percent for each two-hour increment in daily television watching. A study of children pointed the finger at soda and other sweetened drinks. The researchers found that these drinks not only add extra calories but crowd out milk and reduce intake of protein and other healthful nutrients.
Doctors and health care organizations are beginning to view obesity as a serious, pervasive – and yet preventable – health risk. We reached this same point a generation ago with smoking. It’s hard to quit cigarettes. It may be harder to kick the habits of inactivity and overeating that are fattening many of us.
The first was a massive review that combined the results of 23 randomized trials comparing angioplasty with treatment using the clot-busting drugs. The conclusion: Angioplasty is better than clot busters at reducing short-term mortality, second heart attacks, and strokes. It also proved to be superior over the long term.
In the other study, Danish researchers compared heart attack patients treated with clot-busting drugs at local hospitals to those who were transported to larger hospitals for angioplasty. The death and stroke rates were the same in the two groups, but the patients transported for angioplasty had fewer second heart attacks (1.6 percent vs. 6.3 percent). Meanwhile, still a major setback for angioplasty is the speed of transporting patients fast enough to hospitals where an emergency angioplasty setup could be readily arranged.
They recommend that thiazide-type diuretics (sometimes called "water pills"), either alone or in combination with another blood pressure drug, be the frontline treatment for most people with hypertension. It was a back-to-the-future change: Diuretics have been around for years, but they’ve been somewhat overshadowed by heavily marketed calcium-channel blockers and ACE inhibitors.
The guidelines also created a new prehypertension classification: A systolic pressure (the top number) of 120-139 and a diastolic pressure (the bottom number) of 80-89. Unless there is some "compelling indication" – like heart failure or diabetes – if you’re prehypertensive, you’re not a candidate for medication. But you should change your diet and get more exercise to avoid graduating to full-blown hypertension.
Last May, however, another analysis of the data from the Women’s Health Initiative (WHI) showed that the risk for dementia and cognitive decline went up, not down, among women taking estrogen-plus-progestin pills. The WHI is the large, randomized trial of HRT that has been the source of many studies over the past couple of years.
The culprit appears to be progestin, an artificial version of the natural hormone progesterone. Researchers stopped the WHI study early when it became clear that the risks from estrogen-plus-progestin therapy swamped the supposed benefits. But a large companion study of estrogen-only HRT is continuing. (Usually, only women who have had a hysterectomy take estrogen by itself because without progestin, estrogen increases the risk of uterine cancer.)
Letrozole is also an anti-estrogen, but works by drastically lowering levels of the hormone. A Canadian study last year made front-page news when it found that women who took letrozole for an average of 2.4 years after completing the usual five years of tamoxifen therapy had about half (43 percent) the recurrence rate of those given a placebo. Letrozole or similar drugs may fill the post-tamoxifen void in breast cancer treatment.
Some breast cancer advocacy groups say the study was stopped too soon. Side effects (osteoporosis, heart disease) could be a problem. And no one knows how long women should take the drug.