Editors of the Harvard Health Letter, in consultation with the doctors on its editorial board, have chosen the top 10 health stories of the year. Here are this year's winners
1. A new shot in the arm against cancer. One of the oldest and most effective of the screening tests has been the Pap smear for cervical cancer. With the new HPV vaccine, we are seeing the emergence of a different approach that recruits the immune system to the fight against cancer. Approved in 2006 by the FDA, the vaccine is designed to immunize women against infection by two strains of HPV, which are believed to cause some 70% of cervical cancers. Because of the remaining 30%, Pap smear screening will remain important.
2. Trans is fat non grata. If there's good (monounsaturated) and bad (saturated) fat, then trans fat belongs in its own horrendous category. Consider its metabolic rap sheet: increases "bad" LDL cholesterol; increases triglycerides; decreases "good" HDL cholesterol; makes platelets get stickier than usual so blood clots are more likely; may have pro-inflammatory effects.
In 2006 it became easier to avoid trans fat after the FDA required that it be listed on the Nutrition Facts label on packaged food. Buyers beware, though: Manufacturers are allowed to list the trans fat content as zero if the product contains less than 0.5 grams per serving.
3. Has Massachusetts figured it out? In April 2006, Massachusetts adopted the most promising plan yet for universal health insurance coverage. The law combines subsidies to those who can't afford health insurance with a mandate that everyone have it — and the mandate has some bite: If you can afford health insurance but don't have it, you'll pay a penalty that's based on the prevailing cost of health insurance.
Whether Massachusetts will be a beacon or an outlier is hard to say. Since only 6% of Massachusetts' residents lack health insurance, the uninsured are a much bigger problem elsewhere.
4. New treatment for macular degeneration. In 2006, a promising new approach appeared, focusing on angiogenesis, or the formation of blood vessels. In June 2006, the FDA approved ranibizumab (Lucentis), an anti-angiogenic drug aimed at the blood vessels that cause wet macular degeneration. Studies have found that the drug improves vision, a remarkable result. Up to now, "successful treatment" of macular degeneration usually meant halting further deterioration.
Ophthalmologists have reported good results with a cancer anti-angiogenic compound, bevacizumab (Avastin). Bevacizumab is a larger molecule than ranibizumab, so it may stay in the eye longer and be more effective. It's also a great deal less expensive. Experts have called for a head-to-head clinical trial.
5. Germ warfare — and the germs are winning some battles. We've been hearing about the rise of "superbugs" for quite some time, but in 2006 they're causing more trouble than ever. CA-MRSA stands for community-acquired methicillin-resistant Staphylococcus aureus, a bacterial skin infection that people used to get only in the hospital but is now circulating outside the health care system.
Extensively drug-resistant tuberculosis (XDR-TB) is impervious even to second-line drugs. C. difficile is short for Clostridium difficile, a species of bacteria that usually moves into the gut after antibiotics prescribed for another infection have wiped out the healthful bacteria that normally reside there. C. difficile, like CA-MRSA, is now infecting healthy people outside the hospital.
Scientists are working on newer and more effective antibiotics. We can also fight back by taking simple steps, like washing our hands more often. But this war will drag on, so we'd better get used to it.
6. Vaccines, kid stuff no more. In 2006, the agency approved Zostavax, the first vaccine against shingles, a condition that typically affects people over age 60. Convincing adults to get the shots may be hard. Health officials can use school and summer-camp requirements to increase vaccination rates among children. But for adults, the inducements may be harder to come by.
7. Drug approvals — with strings attached. Hopes were high when natalizumab (Tysabri) was introduced in 2004 to treat multiple sclerosis. But then Tysabri was withdrawn after being linked to three cases of an unusual brain infection.
In 2006, the FDA allowed Tysabri back on the market, with restrictions. Doctors prescribing it must register with the manufacturer. The monthly infusions can only be given at authorized sites. Patients must also be registered in a special Tysabri program. Alosetron (Lotronex), the irritable bowel syndrome drug, followed a similar path earlier.
Drug approvals have generally been binary, yea or nay, with doctors free to prescribe any approved drug. With Tysabri and Lotronex, we're moving toward modified approvals with requirements for monitoring attached.
8. Bird flu preparations: Don't chicken out now. There's been a bit of bird flu fatigue in 2006 — in the media and the general public. The H5N1 virus hasn't mutated into a form that's easily transmissible from person to person, and no worldwide epidemic has developed. But flu experts punctuate such statements with an ominous "so far." Flu pandemics are recurrent.
The World Health Organization's plan to contain an outbreak includes using huge quantities of antiviral medications. Vaccine development inches forward, but there's a fundamental problem: There's no way of knowing which variant of the virus we should target. H5N1-type virus is a strong possibility, but some other virulent flu bug could make the jump to humans first. These difficulties argue for more preparation for pandemic flu, not less.
9. Calls for FDA reform getting louder and clearer. In September 2006, an expert committee created by the Institute of Medicine released a report calling for two dozen reforms. One major theme: The approval process will never ferret out all the problems with a drug, so the agency needs tough, new powers to improve the monitoring of drugs after they are on the market. The committee also proposes that the United States copy Britain by having all new drugs carry a special symbol, such as a black triangle, for two years so that consumers know that the drugs are new and lack a track record.
10. D: Finally, a vitamin that makes the grade. Several studies in 2006 have suggested that the so-called sunshine vitamin — because it's produced in skin exposed to sunlight — may protect against cancer. California researchers reported that as blood levels of vitamin D go up, women's breast cancer risk goes down.
Most multivitamin pills contain 400 IU of vitamin D. We probably ought to be getting at least twice that much.
So far, though, most of the favorable findings for vitamin D have come from observational studies. Other vitamins haven't fared so well when they were put to the test in randomized clinical trials.
January 2007 update