Monday, December 29, 2008

The Year in Medicine, from Time

A Synopsis of The Year in Medicine 2008: From A to Z

The financial world blew itself up, the political world turned upside down, but in 2008 the world of medicine just kept chugging. In good times and bad, science doesn't sleep, and every year brings breakthroughs, setbacks, reasons for worry and reasons for joy. TIME's annual alphabetical roundup of a sampling of those stories gives you an overview of the year behind and a hint of what might be in the one ahead.


And Diabetes:Lethal Partners

People with diabetes have a higher risk of developing Alzheimer's disease--and doctors don't know why. But researchers have found that compared with Alzheimer's patients who never developed diabetes, those who had both conditions and received diabetes therapy had 80% fewer brain-clogging amyloid plaques, a physical sign of Alzheimer's. It's not clear why the treatment had this effect, but the hope is that diabetes drugs could reduce symptoms in some and provide clues to new treatments.

Appendectomy: No Cuts, No Scars, No Sweat

Get ready for the "natural orifice" technique. Settle down, it's a surgical procedure. Rather than cutting through skin and tissue to reach organs deep inside the body, surgeons are increasingly experimenting with going through natural openings such as the mouth, vagina and colon. A team at the University of California at San Diego performed the first such operation in the U.S. in March, removing the appendix of a brave graduate student through her vagina. Surgeons say the technique, which uses in-body camera systems to guide doctors, will reduce the number of incisions made through the skin, which in turn should reduce scarring and infections and improve recovery. Depending on the type of surgery, doctors may need to make some incisions through inner tissues and organs, but because those cuts are not exposed, they often heal faster and more cleanly than those made through the skin. And as a bonus, they tend to be less painful as they heal.

Abortion: Rates Down for Some

Fewer women are choosing to have abortions, according to a report by the Guttmacher Institute, a nonprofit organization that has studied abortion rates for more than 30 years. From 1990 to 2005, the total number of abortions in the U.S. fell from 1.6 million to 1.2 million. Despite this drop, the study found that more than 1 in 5 women will have an abortion at some point in her lifetime; however, that rate does not apply equally to all women. Teenagers and young adults ages 20-24 were responsible for much of the decline, while rates increased for women in their 40s. Race also made a difference. In 2004, only 11 out of every 1,000 white women had abortions, compared with 28 per 1,000 Hispanic women and 50 per 1,000 black women.

Autism: Debate Rages over a Rare Case

With her crimson curls and angelic face, little Hannah Poling, a 9-year-old girl with autism, hardly looks like a pioneer. But the Georgia native is the first to receive a mea culpa of sorts from federal health officials, who acknowledged that routinely recommended vaccines she received as a toddler might have contributed to her autism. Poling's case is unique in that she received five injections in one day in order to catch up after falling behind the recommended vaccination schedule. More important, she also has a rare mitochondrial condition that disrupts normal cellular function; this, experts believe, was worsened by the immunizations, causing brain changes. It's one more data point in the continuing war over whether childhood immunizations are linked to autism; scientific studies to date and the Centers for Disease Control and Prevention find no consistent cause-and-effect relationship.


Bisphenol-A: A Chemical Found in Plastic Could Be Dangerous

Dustin Hoffman in The Graduate may be the person who was most famously reminded of the ubiquity of plastics, but a worried band of modern-day scientists are taking up the cry. The investigators are concerned about the health effects of bisphenol-A (BPA), a component in some plastics--including bottles and the lining of aluminum cans--that can easily migrate into the bloodstream. The chemical industry argues that the average dose of BPA is far too low to be harmful--and the Food and Drug Administration (FDA) has agreed. But animal studies have connected even low-dose BPA exposure with cancer and other ills, and the chemical can mimic the hormone estrogen, which can cause feminizing changes in developing fetuses and infants. After the FDA ruled the chemical safe, research published in the Journal of the American Medical Association found that higher levels of BPA in people were associated with greater incidences of cardiovascular disease, diabetes and liver problems. In Octobe
r, a review panel commissioned by the FDA's science board found that the federal agency's original assessment was flawed. It's up to the FDA to determine how to respond, but parents may want to avoid BPA when they can.

Brains: How Gay and Straight Differ

Ever since scientists realized that the seat of love and lust is not the heart but the brain, they've been looking for how the brains of homosexuals and heterosexuals differ. Researchers in Sweden have new clues. Studying brain scans of 90 subjects, they found that the right hemisphere is slightly larger than the left in both men and women who are attracted to women. Men and women attracted to men, on the other hand, have brains that are more symmetrical. Brain symmetry isn't the whole story, and other researchers have found that additional variables as diverse as genes and birth order can play a role.


CT Scans: Just How Safe Are They?

Computed tomographic (CT) scans help doctors zoom in on everything from head trauma to kidney stones. But some researchers are worried that unnecessary scans may increase your lifetime cancer risk. Long-term studies investigating a tumor connection are under way, but in the meantime, patients may be getting some serious radiation exposure. A study of 1,243 randomly chosen hospital patients showed that, on average, they had been exposed to 45 millisieverts (mSv) of radiation (the typical chest X-ray delivers 0.02 mSv), and 12% had been exposed to more than twice that amount. And not all of this exposure may even be necessary. Earlier studies have suggested that some doctors order duplicate scans, while others prescribe CTs in an abundance of caution, just to rule out potential diseases.

Cigarettes: Quitting Causes a Chain Reaction

Diseases are contagious, and so, it turns out, are behaviors like quitting smoking. Researchers at Harvard and the University of California at San Diego have found that a person in one part of a social network was 20% more likely to quit smoking if a person in another part of that network quit, even if they were several degrees removed from each other, or even--remarkably--if they didn't know each other at all. The person quitting influences others who eventually influence you.

CPR: One, Two, Three, Four, Stayin' Alive

Properly performed, CPR can triple the chance that someone survives a heart attack, but even the best-trained Good Samaritans can have trouble finding the right rhythm and pace for the chest compressions. Unless, that is, they're disco fans. A 15-doctor study found that teaching CPR to the tune of the Bee Gees' song "Stayin' Alive" (the snappy anthem of the movie Saturday Night Fever) helped students perform the compressions at the proper speed and pace on a test five weeks later. Who said disco was dead?

Cerebral Palsy: Epsom Salts Lower Risk

Advances in neonatal care make it possible to save more and more premature babies, but while the preemies' lives are spared, their brains may not be. Preterm birth accounts for about a third of all cases of cerebral palsy (CP), a developmental disorder that strikes 2 out of every 1,000 U.S. newborns. Some experts predict that as the number of preemie survivors climbs, the population of kids with CP will move in lockstep. But a study of 2,241 pregnant women has delivered encouraging news. Researchers found that if mothers take magnesium sulfate--commonly known as Epsom salts--just hours before giving birth at 24 to 31 weeks of gestation (40 weeks is full term), the odds that their infants will develop moderate to severe cerebral palsy drop by almost half.


Day Care: A Weighty Choice

Parents have long anguished over whether they should send their preschool kids to day care, and thus far, the mixed bag of research hasn't been much help. Some studies show that day care boosts academic performance, while others say toddlers have fewer behavioral problems if they stay home. For parents, the should-we-or-shouldn't-we decision only got tougher in July when a paper published in the Archives of Pediatric and Adolescent Medicine found that over a nine-month period, babies in day care gain 0.4 lb. more than those who stay home. The researchers--who studied more than 8,000 9-month-olds--suspect that infants in day care are heavier than those cared for by a parent because they have less structured eating habits. Sometimes weight gain can be a good thing for infants who are underweight, but for others, it could be a risk factor for developing childhood obesity.


Fertility: New research yields fresh insights into courtship, conception and when our baby-making years stop


Women aren't the only ones with a biological clock. New studies show that men have one too--and it may slow down early, around age 24. As with women who conceive past their peak, older men also increase the odds of having a child with an abnormality like autism or Down syndrome. One study of couples undergoing fertility treatments found that the father's age had as big an effect on conception and miscarriage as the mother's. Another study showed that men older than 40 were more likely to have a child with bipolar disorder.


Every woman over age 35 is mindful of menopause, but it's impossible to know how fast it's coming. That may change soon, thanks to scientists at the University Medical Center Utrecht in the Netherlands. Earlier this year, they discovered that a simple blood test that detects the anti-Mullerian hormone (AMH)--a chemical that helps track egg supply--can predict when a woman will enter menopause. A high AMH level shows that the woman's ovaries are still releasing lots of eggs. By comparing levels of the hormone in women ages 25 to 46 with those of postmenopausal women 58 to 70, the researchers were able to establish cutoff points that could portend when the change will occur and, by implication, suggest how many years of fertility are left. More research still needs to be done, but it may not be long before women are able to predict their fertility timetable much more accurately.


Listen up, especially if you're thinking of having a child: a UCLA study has shown that women's voices get higher (and more alluringly feminine) as ovulation (and increased fertility) approaches. Researchers recorded the voices of 69 women during high- and low-fertility phases and found that as fecundity climbs, so does pitch. Surprisingly, voice changes occurred only when the women spoke an introductory sentence ("Hi, I'm a student at UCLA") and not when they pronounced vowels. This could suggest that the variation happens just when people are conveying a message, and so it's done, unwittingly, for effect. The research adds to a chorus of studies demonstrating that humans exhibit other cues, such as dressing differently, around ovulation. As for women who are ovulating and don't want to advertise that fact? Try e-mail.


Gardasil: Vaccine Battle?

It's the first vaccine for the sexually transmitted human papillomavirus, which causes genital warts and cervical cancer. But girls vaccinated with Gardasil since 2006 have experienced some serious side effects, including seizures and fainting, and 27 teens died after receiving the shot. An ongoing study is investigating whether these events were caused by the vaccine; health officials say the shot is safe.

Global Warming: A Hot Earth Could Worsen Allergies and Kidney Stones

It may not rank with rising sea levels and crippling drought, but hay fever is one more thing global warming is likely to make worse. A study in the September Journal of Allergy and Clinical Immunology found that increasingly early pollination of olive trees in Spain led to higher pollen counts overall. Similar outcomes can be expected in temperate areas elsewhere as the earth warms. That's bad news for everyone--particularly the 300 million asthmatics around the world. Research published in the Proceedings of the National Academy of Sciences also links rising temperatures to an increase in kidney stones--a condition related to dehydration. In 2000 some 40% of Americans already lived in warm parts of the country considered kidney-stone risk areas. That number is expected to reach 70% by 2095. There has also been an increase in the number of children with kidney stones over the past year. But don't blame global warming: the real cause may be too many salty snacks.

Genetically Modified Foods: China Has the World Worried

China is charging into the 21st century--but its food-inspection system is mired in the 19th. Last year saw a series of tainted-food scandals. But consumers are just as concerned about genetically modified (GM) crops. The country is pumping funds into genetic research in the hope that better crops will help the land of 1.3 billion people feed itself. Given the gaps in China's food-safety net--and the potential for GM food to get out of control--that possibility is worrisome.

Gymnastics: Graceful, Exciting--And Disturbingly Dangerous

Gymnastics can be the most nail-biting event of any Olympics--but the worry isn't always over who'll win the gold. The first national study of gymnastics injuries, conducted by Nationwide Children's Hospital in Ohio, shows that gymnastics is among the most perilous sports for girls. Analyzing records of patients ages 6 to 17 who were treated in emergency rooms from 1990 to 2005, the study found that an average of 5 out of every 1,000 young gymnasts each year--about 27,000--required medical attention for injuries ranging from sprains to nerve damage. Safer equipment and better training methods, however, may be making a difference. Injuries fell 25% over the 16-year period.


HIV: The Hunt for the Elusive Vaccine Goes On--and On

The road to an HIV vaccine hit another gully when the U.S. government canceled a trial of its most advanced experimental formula to date. The two-shot injection was similar to one that Merck developed and scrapped in 2007, after initial results showed that not only did it fail to protect against HIV, but in some cases it actually increased the risk of infection. Both vaccines were designed to test a new approach, one based on activating the body's cell-based immunity, in which killer immune cells take a more dominant role than antibodies in attacking HIV. Experts now believe not enough is known about this strategy to make a large-scale trial useful--yet. Researchers are hopeful the approach still holds promise; smaller studies are under way to work out how best to harness the body's virus-fighting cells.


Inflammation: Putting Out The Fire in the Heart

If you've struggled to lower your cholesterol levels to some presumed "safe" zone, you might have wondered how much good all that work did when you learned that half of all heart attacks occur in people with normal cholesterol. The good news is, researchers have fingered a culprit: inflammation, which may be as important as cholesterol in causing heart disease. The better news is that a test for something called C-reactive protein (CRP) can tell you your risk. If it's high, the same statins that help control cholesterol can lower CRP as well. In one study, people with high CRP who took a particular statin had 54% fewer heart attacks than those given a placebo.


Knee Surgery: Doubts About A Popular Procedure

One more reason to think twice before you have arthroscopic knee surgery for osteoarthritis: a study published in the New England Journal of Medicine suggests that the procedure does no better at relieving symptoms than physical therapy or anti-inflammatory drugs. What's more, patients who do feel improvement after surgery may merely be experiencing a placebo effect. This finding echoes a 2002 government study showing that outcomes were similar whether a patient underwent real arthroscopic surgery or a sham procedure in which an incision was made but no actual work was done. That study prompted Medicare to drop coverage for the surgery as a treatment for osteoarthritis.


Lung Cancer: Genes Identified

Smoking is the leading cause of lung cancer, but how is it that so many smokers never develop the deadly disease? A collection of reports in the U.S. and Europe may have found an answer in the genes. Researchers identified two gene variants in 34% of the population that code for cell-surface proteins that in turn bind to nicotine molecules. Clamp nicotine to the cell this way, and dramatic changes can result, including amplified growth of blood vessels in the lungs, which can create an environment particularly well suited to greedy cancer cells. The studies determined that smokers who had one of the gene variants were 28% more likely than other smokers to develop lung cancer, and those with both had a staggering 81% higher risk. What's more, researchers found that smokers who have either of the gene variants may have a greater tendency toward nicotine addiction and are likely to smoke more often during the course of a day.


Math: Girls Catch Up with Boys, And the Gender Gap Disappears

We've all heard it before: boys are simply better at math than girls are. But according to a new study published in Science, the math gender gap has vanished. Previous studies showed that boys start to outscore girls in math once they reach high school. Information gathered last year from the math tests of 7.2 million kids in Grades 2 to 11 in 10 states, however, revealed that there are no longer any significant differences between boys' and girls' average scores. Similarly, an equal number of both sexes were found to perform so well that they ranked among the highest mathematical achievers. Scientists say the results show that more girls are taking math courses and, most important, sticking with them as they get older.

Malaria: The Global Tally Drops

Good news--well, sort of. Earlier this fall, the World Health Organization cut its global tally of malaria cases in 2006 at least 40% from the previous year's estimate--but that still means there were 247 million cases in 2006. The drop had less to do with a real improvement in health than a simple change in number-crunching. Once figures from India and elsewhere in Asia were updated, the numbers fell. In November 2007, the U.N. came under fire when it overestimated the number of HIV cases worldwide by more than 6 million, an act that critics say was used to spur donations. No matter how the calculations are done, epidemiologists warn that the math will always be tricky.


Obesity: You Can Beat Your Genes

Everyone who has struggled with losing weight knows that sometimes the spirit is willing but the genes are weak. Still, there's hope: a study of the Amish found that even people with a genetic predisposition to gain weight can control their body size. Some subjects carried a fattening variant of the FTO gene associated with obesity. The Amish FTO carriers were indeed an average of 7 lb. (3.2 kg) heavier than people without the gene. Even within this subgroup, however, some were able to avoid getting fat--thanks to simple exercise. The catch was that it took a lot more physical activity for people with the gene variant to stay slim than for those without it. Still, in this one case, we can apparently nurture nature.

Obesity: Levels Hit Plateau for The First Time in Decades

Finally some headway in the fight against childhood obesity. For the first time in nearly three decades, the epidemic may be leveling off. Last May, a study published in the Journal of the American Medical Association found that the prevalence of overweight and obese kids in the 6-to-11-year-old age group appeared to have hit a plateau of about 32% from 1999 to 2006. Experts say that the leveling off may be due not to better diet and exercise but to the possibility that we've hit a sort of genetic ceiling, with the entire population of children susceptible to gaining too much weight having done so.


Reading: A Novel Way to Lose Weight

How do you convince overweight kids to get serious about losing weight? Get them to read. Dr. Sarah Armstrong, director of the Healthy Lifestyles Program at Duke Children's Hospital, enrolled 31 obese girls in a six-month comprehensive weight-loss program and had them read a novel whose protagonist is an overweight teen who learns to eat and live more healthfully. Another group of girls in the study read a book that did not have an overweight heroine, and a third group read nothing. At the end of the weight-loss program, the girls who had read the book about the overweight character lost more weight than did those in the two other groups. Sometimes, it seems, the most persuasive voices don't have to come from the real world at all.


Statins: Grade-School Kids On a Middle-Age Drug

With obesity rates among youngsters remaining high, the American Academy of Pediatrics took a drastic step by recommending cholesterol-testing for kids as young as 2. The move is targeted at children whose families have a history of elevated cholesterol and who might benefit from cholesterol-lowering drugs known as statins. Some doctors view the move as a defense against the possibility of a generation of unhealthy kids living shorter lives than their parents did. Others worry that the policy could expand the use of statins to kids without giving them the chance to make tough changes in the behaviors that led to their weight and cholesterol problems in the first place.

Salmonella: A One-Two Punch

It took nearly four months for the FDA to clean up the damage from the largest outbreak of food-borne illness in more than a decade. The culprit: some contaminated jalapeNo and serrano peppers that were exported from Mexico to the U.S. early last spring. In the end, at least 1,440 people in 43 states became sick from salmonella, a potentially life-threatening bacterium. By August, the FDA had finally lifted its warning on the peppers and some tomatoes and promised consumers it would tighten safety regulations. Not long after that crisis passed, a milder one struck. Thirty-two people in 12 states came down with salmonella in October after failing to cook a brand of frozen chicken dinners--which appeared to have already been cooked--thoroughly enough.

Stem Cells: Brave New World

Score one for the scientists. Seven years after the Federal Government banned the use of most embryonic stem cells, investigators have found ways to generate stem cells without using politically and ethically charged embryos at all. For the first time, scientists at Harvard developed motor neurons from a patient with Lou Gehrig's disease, using just some skin cells and four genes. And in another first, their colleagues managed to generate insulin-producing cells from pancreatic cells simply by manipulating the two to switch identities, bypassing the stem-cell step altogether. Both are research milestones that also make it possible for scientists to watch diseases unfold in a petri dish and eventually, they say, develop new cures.


Testosterone: Does It Make You Money?

Testosterone levels among traders were higher on days when they made better earnings, and the higher their morning levels were, the more money they tended to make by the end of the day. But chronically high levels blur the perception of risk--and after the crash of 2008, we know what that can do.

Transplants: Get the Organ And Hold the Drugs

Few things are more tragic than desperate transplant patients who finally receive a long-awaited organ only to have their bodies reject it. Now there may be a way to prevent that. In a study of five kidney-transplant patients whose donors were not exact matches, doctors primed the recipients' immune systems by lowering their level of protective T cells, then gave them some of the donor's bone marrow at the time of surgery. This created a sort of hybrid immune system. Four of the patients accepted the kidneys and were able to go off immunosuppressive drugs within a year of surgery.

Television: A Teen-Pregnancy Link

Television's influence on young viewers is a perennial hot topic. Now a Rand Corp. study gives parents one more reason to worry: too much TV may be associated with teen pregnancy. On the basis of phone surveys with 718 teens ages 12 to 17, researchers found that girls and boys exposed to high levels of sexual content on TV were twice as likely to be involved in a pregnancy by age 20 as were kids who watched less. This follows research that revealed a link between exposure to sexy TV and earlier initiation of intercourse. The investigators point out that not only do TV characters obsess about sex but they also don't think much about contraception--a reckless message for impressionable kids.


Vytorin: Science Vs. Hype

If one cholesterol-lowering drug is good, two must be better. That was the thinking behind Vytorin, a combination of Merck's Zocor and Schering-Plough's Zetia. Not so, it turns out. A study of 750 patients showed that while the combination did lower bad cholesterol, or LDL, it did little more to reduce the dangerous buildup of plaque than Zocor alone did--which costs far less than the combination drug Vytorin.


ZZZ: Don't Let This Keep You Up

Troubled sleep can cause problems for anyone, but for women, the consequences may be even more dire. In a study of 210 men and women, Duke University researcher Dr. Edward Suarez found that women who slept poorly had elevated levels of several risk factors for heart disease and diabetes--including cholesterol, insulin, glucose, inflammatory proteins and the clotting agent fibrinogen--but men who tossed and turned did not. The reason may have something to do with testosterone. Men who reported the most difficulty sleeping also had the highest levels of testosterone, which is known to reduce concentrations of heart-damaging inflammatory proteins. It's not certain if testosterone somehow contributes to the sleeplessness or if it's somehow released protectively in men who don't get enough z's. No matter such details; for both sexes, better sleep will almost always mean better health.


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Ruca said...

What an incredible year (and alot to digest in one post.) I do wonder exactly how epsoms salts work to lower the Cerebral Palsy risk, and if it couldn't also be used as a preventative measure in women carrying to 40 weeks as well.

Sachin said...

What an incredible year. I do wonder exactly how epsoms salts work to lower the Cerebral Palsy risk, and if it couldn't also be used as a preventative measure in women carrying to 40 weeks as well.