Originally published in The Ottawa Citizen December 30, 2003
Original Title: The top medical news stories of the year

The December issue of the Harvard Health Letter reviews the top 10 significant medical achievements and events for 2003 and their potential impact.

Here is my take on the Harvard list. In many cases, I have included the relevant website address where you can read previous columns I have written on the subjects.

1. Adult and childhood obesity is the world’s No. 1 health issue. There is increasing recognition that lifestyle, eating habits and food choices play an important role in the development of obesity for many, but not all, individuals. There are ongoing studies examining various hormonal abnormalities within the brain that lead to obesity as well. (Check out my previous column at http://members.rogers.com/barrydworkin/childhood_obesity.html.)

2. The SARS threat was eventually contained. Many lessons about infectious disease control and prevention measures were learned. New protocols and models were developed for future infectious disease emergencies.

3. The discovery that Apo1 Milano protein probably prevents heart attacks. The Cleveland Clinic in Ohio injected the protein into heart disease patients. Within five weeks, years of cholesterol plaque buildup in the coronary arteries disappeared. More studies are to follow.

4. New blood pressure guidelines dramatically reduced the cutoff for the diagnosis of hypertension. An old drug, a diuretic, was recommended as a first-line treatment choice. However, most Canadians with hypertension are untreated or do not follow their medication regimen. (See http://members.rogers.com/barrydworkin/needless_suffering.html.)

5. Recommendations for preventive services and medical guidelines are not being followed as well as they should be, according to a study. (http://members.rogers.com/barrydworkin/get_a_checkup.html.)

6. The natural effects of aging are slowing. More integrated public health measures, lifestyle choices and medical advances combined with social and economic support for older people have turned back the aging clock by at least five years.

7. Hormone replacement therapy was dealt another blow when the Women’s Health Initiative study showed the risk for dementia increased for women taking estrogen-plus-progestin pills.

8. Low-carb diets return with a vengeance. Two New England Journal of Medicine studies showed the Atkins diet, in the short term, was a safe way to lose weight (except with some medical conditions). (http://members.rogers.com/barrydworkin/low_carb_diet.html.)

9. A study this year announced that Letrozole, an aromatase inhibitor, reduced breast cancer recurrence by half. Women who took letrozole for an average of 2.4 years after the usual five years of Tamoxifen therapy had a 43-per-cent relative reduction rate of cancer recurrence compared to placebo. However, the absolute reduction was one recurrence per 100 women per year. (See http://members.rogers.com/barrydworkin/breast_cancer_treatment.html.)

10. Early strides into the genomic era. Companies are developing devices that read specific DNA sequences for various genetically inherited diseases and conditions. Potential risks for colon and breast cancer, among others, could be detected in a drop of blood taken from a child and treatments could be tailored for each person’s genes.

As for the future, I expect we’re certain to face more infectious disease outbreaks. There is concern that SARS will return and that a flu pandemic will appear within the next decade.

Technology continues apace. New vaccines for the prevention of cervical cancer are in the testing phase. Virtual colonoscopies, PET scanners and other non-invasive technologies are opening up new and safer means of improving early detection and diagnosis of certain cancers.

The question is whether society will be prepared to pay for these advances.

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© Dr. Barry Dworkin 2003