Tuesday, January 1, 2008

Best and Worst of 2007

Looking back at 2007, there were many ups and downs in the area of health and health care. Here are a few of the top items that kept my attention.

The Best
1. Getting Rid of Trans-fats. Though the decision was made in the end of 2006, in wasn't until July 2007 when The New York City Board of Health's decision to adopt the nation’s first major ban on the use of trans fats in restaurant cooking took affect. This set off a chain reaction which is leading to some healthier food in restaurants across America.

2. Medicine just as good as procedures for stable angina. In this study published in the New England journal, over 2000 patients with stable angina (heart disease and chest pain, but no heart attack yet) were randomized to angioplasty (an invasive procedure) or just medications. There was no difference in death or heart attack rate at the end of the study.

3. New asthma guidelines available. Though this arrived with little fanfare in the press, the fully updated NIH asthma guidelines has been anticipated for a decade. The new guidelines give doctors a different approach to asthma focusing on disease control and risk for future events. I am hopeful that his new approach will help curtail the over 2 million ER visits a year due to asthma.

4. Breakthrough drug for muscular dystrophy. Also met with little fanfare, likely because it was just a safety study in 4 boys and didn't really change their disease, this recent study is the first real human trial of a drug that knocks out genetic defects. If successful, this approach may not only cure diseases like muscular dystrophy but could be used in other genetic diseases and even cancer.

5. Better ways to find breast cancer. A study published (again) in the New England journal took nearly 1000 women who had been diagnosed with breast cancer in one breast, looked at MRI's of the other breast where mammography was negative. They found lesions in over 100 women, 25% of which were cancer. This and other studies led to changes in guidelines from the American Cancer Society who recommends MRI for certain women at very high risk of breast cancer (20-25% life time risk- you can calculate your risk here).

The Worst
1. Pfizer pulls Exubera. So many of my diabetic patients who need insulin refuse to every try it because of the idea of injecting themselves. I was one of the first doctors to prescribe the new inhaled insulin, Exubera. Though not perfect, Exubera was a great additional tool in our battle to fight diabetes. Unfortunately, it wasn't making enough money, and Pfizer pulled the plug. I would understand if the company just stopped marketing it, but to stop making it was a hard hit for some patients who saw this product as a life saver.

2. Avandia scare. I put this on my worst list not because of that avandia was found to cause heart attacks (the FDA now says the data is inconclusive) or because of all the flaws found in the study that caused the controversy, but because of the many patients who were confused and scared by all the media hype, and stopped taking the drug, many without discussing it with their physician.

3. MRSA in the community. Up until recently, this scary bug was confined to hospitals. This will be an ongoing problem for 2008. The New York times has a great "What you need to know" piece on this.

4. No go on HDL drug. The cholesterol lowering drugs called "statins" are life savers, reducing heart attacks, strokes, etc. by 25-30%. However, this not 100% or even 50%. Low hdl (good cholesterol) has an even stronger association with heart disease then the ldl (bad cholesterol) that statins treat. There was great excitement about a new drug about to come to market that would dramatically improve hdl, but safety issues prevented this drug from being approved, and Pfizer's $1 billion investment went down the drain.

5. No go on obesity drug. Rimonabant was another highly anticipated drug that could help with smoking cessation, diabetes, and most importantly weight loss. Though the drug is currently available in Europe, the FDA did not approve this drug because of increased psychiatric side effects. Though likely the right decision, this very disappointing.

Happy New Year!

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