Top Health Stories of 2009

Each year editors of the “Harvard Health Letter” in consultation with the doctors on its editorial board choose the top 10 health stories of the year. Here are four of the items on the list for 2009:

[ HOLIDAY WELLNESS WEEK ]

>H1N1 Flu: Most of the news about 2009's H1N1 "swine flu" pandemic has been reassuring. While the H1N1 virus spreads easily and makes people sick, so far it's rarely life-threatening. A major reason for the calm has been the measured public-health response. Plenty of information has been made available, and health officials gave us simple, concrete things to do to protect ourselves. A vaccine was developed and put into production, although shortages have been a serious concern. We have weeks of flu season ahead of us and much could go wrong, but early indications show that this pandemic will stay manageable.

>Health Care Reform: The final version of proposed legislation was still taking shape as the “Harvard Health Letter” went to press, and the outcome is still in doubt, but some basic elements of health care reform looked to be in place: a mandate requiring individuals to buy health insurance, tighter regulation of health insurers, and the creation of computerized "exchanges" where people and small employers can shop for affordable policies. But chances are that legislation -- if it does become law -- won't do nearly enough to control costs.

>Screening Tests: Fresh doubts emerged about the screening tests for breast and prostate cancers. A provocative analysis in The Journal of the American Medical Association came to the conclusion that the past 20 years of screening mammography for breast cancer and prostate-specific antigen testing for prostate cancer have led to detection and treatment of many cancers that pose minimal risk, while achieving only modest reductions in the number of more advanced cases. The U.S. Preventive Services Task Force came out with new mammography guidelines that said most women should not start getting mammograms before age 50 (the old guidelines said 40) and that it's best for the tests to be done every two years -- instead of every year. A huge controversy ensued, which shows, if nothing else, that screening mammography is far from a settled issue.

>An Alternative to Warfarin?: Millions of people depend on the blood-thinning drug warfarin (Coumadin), especially those with atrial fibrillation. But warfarin interacts with dozens of drugs and herbs and some foods, and frequent blood tests are often necessary to make sure the blood's clotting capacity stays in a safe range. Patients and their doctors have accepted these drawbacks for lack of a good alternative. But now, a good substitute might have been found. A new drug called dabigatran acts directly on thrombin, one of the key players in the formation of blood clots, and does not require blood monitoring. It has far fewer interactions with other drugs, herbs, and foods than warfarin. But the news isn't all good. In trials, heart attacks and gastrointestinal side effects were more common among those taking the new drug than they were among those taking warfarin. The FDA is expected to approve dabigatran in 2010.

Other items on the top 10 list:

>New findings about "good" and "bad" body fat.

>Restrictions on industry gifts to doctors.

>MicroRNA-based treatment.

>Changes in blood sugar goals for patients in intensive care.

>Testing for C-reactive protein.

>Social networks as conduits for health and disease.