The first-ever cancer vaccine tops WebMD's list of the top 10 health stories of 2006.
But that wasn't the year's only advance. 2006 saw an experimental gene therapy cure two people of late-stage cancer. There's now a vaccine for shingles, one of the most feared diseases of the elderly. And early in the year, the FDA approved the first — but certainly not the last — non-injection insulin.
The year also saw new uses of older technologies. The Plan B morning-after pill can now be sold without a prescription. HIV tests will now become routine.
And with New York City's ban on trans fats, war on this manmade heart toxin shifts into high gear.
Not all the news was good news:
The biggest health story of the year is a huge milestone for women's health: FDA approval of Gardasil, the first cancer vaccine.
The FDA's June 2006 action was based on the strong recommendation of its advisory panel. In October, the CDC's Advisory Committee on Immunization Practices (ACIP) provisionally put the HPV vaccine on the childhood vaccination schedule (the final decision, originally scheduled for November, was still under review by the Department of Health and Human Services in mid-December).
HPV is a sexually transmitted infection, which means it affects males as well as females. So far, however, the vaccine is approved only for girls and women aged 9 to 26.
The vaccine doesn't stop HPV from causing cancer or genital warts in a person who's already infected.
That's why the HPV vaccine ideally should be given to girls before they become sexually active. Routine vaccination is recommended for girls aged 11-12. Girls as young as age 9 may get the HPV vaccine at their family doctor's discretion.
However, women who are sexually active should still get the vaccine. And the vaccine doesn't protect against all strains of HPV, so regular cervical-cancer screening — and HPV tests — still are needed.
2. War on Trans Fats
Perhaps the biggest health announcement of 2006 was New York's ban on trans fats.
Described by some nutritionists as a man-made toxin, the fats must be gone from New York City restaurant fryers by July 2007 and from all restaurant food by July 2008. At that time, New York will join Tiburon, Calif., as the second trans-fat-free city in the U.S.
The New York announcement marked the end of a bad year for trans fats. On Jan. 1, the FDA required all foods to list their trans fat content on labels.
Paradoxically, trans fats — also known as partially hydrogenated vegetable oils — were invented as a healthier alternative to animal fats. Food makers quickly found that trans fats give fried food a tasty crunch and baked goods a longer shelf life.
It wasn't long before doctors realized that trans fats might be the unhealthiest fats of all. Just 2.6 grams a day of trans fat raises your risk of heart disease. That's about half as much as you get in a typical serving of French fries.
Trans fats are particularly fattening. There's also a trans-fat/belly-fat link. Trans fats not only build up belly fat themselves, but also appear to cause fat from other parts of your body to move to the belly. Abdominal fat is particularly dangerous and contributes to heart disease and diabetes.
Many foods contain trans fats. Some former culprits — such as Oreo cookies — are now trans-fat free.
Fast-food restaurants have been particularly quick to adopt trans fats. But many major fast-food chains are removing trans fats from their recipes. Prominent examples:
Eliminating trans fats will not make fatty foods good for you. Many food items — particularly fried foods — contain unhealthy levels of saturated fats.
3. Shingles Vaccine Cuts Agony of Aging
Until this year, a person who lived to be 85 had a 50-50 chance of getting shingles.
Shingles is the benign name for an extremely painful condition. It's caused by reactivation of a virus called VZV — better known as chicken pox virus. One in five people who have had chicken pox will get shingles.
Chicken pox goes away, but VZV does not. It's a herpes virus that hides out at the base of the nerves, waiting for the immune system to weaken with age or immune-suppressing drugs. When this happens, a person gets painful skin blisters — or worse.
A third of shingles cases become the excruciating condition called postherpetic neuralgia or PHN. When shingles affects the eye, it's called ophthalmic zoster. Ophthalmic zoster may cause blindness as well as unrelenting pain.
In shingles vaccine clinical trials, vaccination prevented shingles in more than half of recipients. And those who did get shingles got far milder cases. Perhaps most important, the shingles vaccine cuts PHN by two-thirds.
4. Food Safety Under Fire
Is the U.S. food-safety system faltering?
This year we've seen warnings of dangerous bacteria in foods that are supposed to be good for you. The list includes E. coli"> in spinach, E. coli"> in lettuce, salmonella in tomatoes, botulism in carrot juice, and, at this writing, still unidentified vegetables contaminated with E. coli"> in Taco Bell restaurants in the Northeast.
There are some things you can do to protect yourself from food poisoning. These include keeping foods refrigerated, looking for signs of deterioration in bagged produce, buying foods with the latest possible "sell-by" date, and tossing out foods that are no longer fresh.
But some public health advocates say the outbreaks underscore problems at the FDA. Indeed, a May 2006 Harris poll found that 70 percent of Americans have a negative opinion of the agency.
However, a December 2006 Gallup poll shows that while Americans are paying more attention to food warnings and nutritional recommendations than five years ago, most trust the federal government to ensure U.S. food safety.
5. Stents: As Safe as We Thought?
Before this year, there seemed no end to the popularity of drug-coated stents. Patients even demanded that their cardiologists use them to prop open their clogged arteries.
Drug-coated stents are the latest thing in the evolving treatment of blocked arteries. But the stent story shows that solving one problem creates another.
First, there were bypass operations. These open surgeries take a blood vessel from another part of the body and use it to bypass blockage in a heart artery.
Then there was balloon angioplasty. It calls for a doctor to thread a catheter into a blocked artery. The catheter inflates a balloon that opens the blocked area.
But the balloon-opened artery sometimes collapses again. So doctors used wire-mesh tubes — stents — to prop the artery open.
Bare-metal stents sometimes get blocked by scar tissue. This led to the invention of stents coated with drugs that keeps the scar tissue from forming.
Now it's clear that drug-coated stents have their own problem. To work properly, a lining of new blood-vessel cells has to heal over the inside of the stent. Drug-coated stents delay this process. Blood clots can form on the unhealed surface of the stent. This means that in rare cases, drug-eluting stents cause heart attacks and sudden death.
How often does this happen? Deepak L. Bhatt, M.D., associate director of The Cleveland Clinic's heart center, tells WebMD that patients "are not dropping in droves due to drug-coated stents."
"The absolute risk to an individual patient is less than one in 200," Bhatt says. But "with a million stents going in each year in the U.S. and twice that number worldwide, this is not trivial."
Fortunately, a combination of two anti-clotting drugs — aspirin and Plavix — cuts the risk from drug-coated stents. Doctors used to wean stent patients off these drugs after six months. Now studies suggest that patients may have to stay on the drugs for at least a year.
But this solution creates its own problem. Patients with bleeding problems — or those who need surgery — can't tolerate long-term anti-clotting treatment.
New kinds of stents eventually will solve this problem. And if history is any guide, they'll pose new challenges, too.
6. MRSA Infection: A Growing Problem
Dangerous, drug-resistant staph infections are a huge problem for hospitals. That problem is getting worse. But the big news this year is that the infections are spreading outside the hospital.
The bad bug is called MRSA — methicillin-resistant Staphylococcus aureus, named for an important antibiotic that usually kills staph germs.
It doesn't kill this one. Neither do other traditional antibiotics. And now MRSA is the most common skin infection seen in city emergency rooms.
Researchers call this bug community-acquired MRSA. The good news is that there are still antibiotics that work against it. And many patients get over the infection simply by having their boils or abscesses cut open and drained by a doctor — don't try this at home.
The bad news is that many MRSA infections are tough to treat. Some scientists think MRSA infections may get nastier as the bad bug evolves into a worse bug. Already — in rare cases — MRSA can be a flesh-eating infection.
7. Plan B Morning-After Pill Goes Over the Counter
There are two morning-after pills — Plan B and Preven. To prevent pregnancy, these emergency contraceptives must be used soon after intercourse.
That's less of a problem, thanks to this year's FDA approval of over-the-counter sales of Plan B.
The approval has some strings attached. Only stores staffed by a health professional can sell Plan B without a prescription. And women under age 18 still need a doctor's prescription.
Plan B cannot cause an abortion. If taken too late, women who become pregnant after taking Plan B have normal pregnancies.
When taken within 72 hours of unprotected intercourse, Plan B prevents pregnancy about 99 percent of the time.
Plan B is even more effective when taken within 24 hours of intercourse. Obviously, over-the-counter availability makes this more likely for more women who choose not to become pregnant.
8. Skin Cancer Gene Therapy: A New Beginning
This year, all that talk about gene therapy became a reality.
Last August, National Cancer Institute researchers reported success with a gene therapy for skin cancer.
Two patients with what would normally be fatal, late-stage melanoma were freed of the disease. Unfortunately, the treatment didn't work on 15 other patients.
The still-experimental gene therapy uses a virus to transfer a gene into a kind of immune cell called a T cell. The gene carries the genetic code for a specific, tumor-targeting molecule. Once T cells are armed with this molecule, they root out tumor cells.
Obviously, a lot of work remains to be done. But NIH Director Elias A. Zerhouni says there's hope that the technique will work not only for skin cancer, but also for a broad range of other common cancers.
9. Inhaled Insulin: A Slow Start
For people with diabetes, 2006 marks the beginning of a new era: no-shot insulin.
Previously, people who needed insulin had to take the life-saving hormone by injection. In January, the FDA approved an inhalable insulin product called Exubera.Market analysts predicted it would be a blockbuster. It yet may be. But patient and doctor uptake has been slow.Some doctors are worried about the long-term safety of inhaled insulin — especially its effects on lung function. They suggest that it should be reserved for patients who cannot or will not use needles.
These questions will, eventually, be resolved. Meanwhile, Exubera marks the start of an era of new options for people with diabetes.
10. Universal AIDS Testing: A Bold Plan
The next time you go to your doctor, you may get a new test — a routine HIV test.
For the first time in the history of the U.S. AIDS epidemic, the CDC has recommended universal HIV testing.
Why? The old system of voluntary testing simply isn't working. Every year, the CDC estimates, 40,000 Americans join the 1.1 million U.S. residents infected with the AIDS virus.
But here's the scariest number: some 250,000 Americans carry HIV but don't know it yet. This means they will not get treatment when it can do them the most good. And it means they will unwittingly transmit the disease to others.
With routine testing, doctors will give HIV tests to every patient who does not specifically opt out of testing.
There is a hitch. HIV testing is a benefit only when it's linked to AIDS treatment. And there's already a shortage of funds — and health workers — for AIDS treatment in the U.S.
By Daniel J. DeNoon
Reviewed by Louise Chang, M.D