It's been a busy year for the WebMD newsroom. Here's our editors' pick of the top 10 stories.
1. Bird Flu Takes Wing
It's the biggest health story of the year - and it hasn't happened yet.
Unlike human flu bugs, the H5N1 bird flu sweeping Asia hasn't yet learned to spread from person to person. If it does, it could be worse than the infamous 1918 Spanish flu - a bird flu that killed tens of millions of people worldwide. It could also be an economic disaster, yet state officials say they can't afford to prepare.
What do you need to know? WebMD puts bird flu into historical perspective, and answers the questions you need to ask - including whether media hype is inflating bird flu fears.
What will we see in the coming year? Bird flu already is popping up in Europe. As wild birds carry the bird flu virus around the world, it may only be a matter of time before the bug hits birds in Africa and America. Scientists are racing to test a new bird flu vaccine for humans and to develop faster, better flu vaccines.
2. The Terri Schiavo Saga - End of Life and Living Wills
After having her feeding tube removed, Terri Schiavo died. Whether the brain-damaged Florida woman would have wanted it this way - or whether she would have preferred to be kept alive at all costs - remains a matter of dispute.
That dispute between family members played out in the most public of ways as the U.S. Congress and Florida Governor Jeb Bush sought to intervene. No matter how we felt about the dispute, Schiavo's sad story made all of us think about our own end-of-life decisions and about seeing to our own living wills.
As intimate details of Schiavo's life and death became public, there was some evidence that her collapse may have been due to an eating disorder.
Whether this was the case or not, the story again served to focus our attention on an underappreciated health issue.
Schiavo's great legacy may be that she's made us all think about our own deaths, and about how we want our families to deal with them.
3. Black Boxes and Pain Drugs
Remember when you used to pop an over-the-counter pain pill without a second thought? Those days ended this year.
Previously underappreciated heart risks forced Vioxx, and then Bextra, off the market. That leaves only Celebrex to represent the new class of pain pills once billed as "super aspirin."
These drugs, known as Cox-2 inhibitors or coxibs, aren't more powerful than older anti-inflammatory pain drugs such as ibuprofen and naproxen.
They are designed to be easier on the stomach than ibuprofen, naproxen, or aspirin. But a recent study questioned even this benefit.
The concerns about the Cox-2 drugs extend to all prescription anti-inflammatory drugs, which are commonly used to treat arthritis and other painful conditions. The FDA recently asked the makers of these drugs to add to their labels new warnings about heart, stroke, and ulcer risks.
Short-term, low-dose use of over-the-counter anti-inflammatory drugs, such as ibuprofen and naproxen, do not appear to increase the risk of heart attacks and strokes. But patients should check with their doctors before taking these drugs for more than 10 days.
Pain drugs aren't the only drugs getting new warning labels. Responding to public outcry, the FDA last year asked more and more drug makers to put new warnings on their products.
The FDA's highest safety warning for approved drugs, a "black box"
warning, was added to the following:
anti-inflammatory drugs), due to heart concerns.
may increase the risk of skin cancer and lymphoma.
potentially serious infections associated with the drug.
The FDA has also asked the independent Institute of Medicine for recommendations on how it might improve drug safety. An IOM panel of experts began holding hearings in 2005.
4. Contraceptives Questioned
Fewer women use birth control today than they did in 1995, even though they are sexually active and do not want to get pregnant. At the same time, more women are seeking family planning advice from a doctor or nurse.
The problem may be compounded by safety concerns that surfaced over a contraceptive patch. In November a warning about the extra estrogen in the Ortho Evra birth control patch raised questions about its safety.
The concern over the birth control patch followed on the heels of a black box warning late last year about bone loss in long-term users of Depo-Provera, a long-lasting injectable contraceptive.
Half of unplanned pregnancies occur in women not using birth control.
These women might still prevent pregnancy by using the morning-after pill, sold as Plan B. But Plan B has to be taken very soon after unprotected sex.
In 2003 an FDA advisory panel recommended approving Plan B for over-the-counter sale. In 2004 FDA officials said no. And in 2005, the FDA kept the approval in limbo by saying it needed more time to consider how to make the drug available to adults while keeping it out of the hands of girls under 17.
5. Tom Cruise Condemns Antidepressants
Like other members of the Church of Scientology, actor Tom Cruise says he doesn't believe depression is caused by a chemical imbalance in the brain, and therefore drugs designed to treat that problem are unnecessary. Last June, during an interview with Matt Lauer on the Today show, Cruise denounced the use of psychiatric drugs.
The Hollywood star told his fans - and everyone else - that psychiatric drugs are harmful, not helpful. He criticized actress Brooke Shields for taking antidepressants for postpartum depression.
There are, of course, debates among medical experts about the proper role of antidepressants and other drugs in the treatment of mental illness. And there are, indeed, risks from taking any drug, including antidepressants. But psychiatrists tell WebMD patients should discuss their concerns with their doctors before taking the advice of Cruise.
Some of WebMD's readers couldn't agree more, taking the web site to task for even considering Cruise's opinion.
6. Medicare on the Mind
For Americans over 65, 2005 has handed them a big decision about Medicare's prescription-drug benefit. And whether to enroll in the program - known as Medicare Part D - is only the first part of the problem.
Choosing from the huge variety of drug plans isn't easy. It means understanding the kinds of medicines a person needs the most - and when. Despite a government web site and help line, confusion reigns.
Medicare's future continues to be debated. The federal health program faces financial challenges, as an aging U.S. population collides with burgeoning health care costs and drug prices.
The U.S. House and Senate each passed very different Medicare/Medicaid plans. Both bills cut Medicare spending.
The Senate bill focuses on cutting costs paid to insurers and drug companies - although it expressly forbids the government from directly negotiating lower drug prices with manufacturers. The House bill would put more responsibility on beneficiaries, with an eye to lowering health care costs by giving patients incentives to keep health expenses in check.
Many in Congress would like to see Medicare become more like private health insurance. In this scenario, Medicare would become more of a premium-support plan. The idea is to cut costs by increasing market competition among insurance providers. Others would like to see Medicare save money by expanding reimbursement for preventive care.
Only one thing is certain: Medicare again will be a big story in 2006.
7. Building a Better Pyramid
2005 New Year's resolutions got a big boost when the U.S. Department of Health and Human Services announced sweeping new dietary guidelines.
The stress is on eating healthy fruits and vegetables, whole grains, and fat-free or low-fat dairy products; limiting saturated fats, sugar, alcohol, and salt; and getting plenty of exercise.
All that got rolled into the U.S. Department of Agriculture's new food pyramid - the first remodeling of this health landmark in 13 years.
It's more than a single pyramid. The new MyPyramid lets you build a food pyramid based on your own health needs. And there's even a new kids' food pyramid.
8. Katrina and Rita: A One-Two Punch
When Hurricane Katrina devastated New Orleans and other parts of the Gulf coast, it left huge health problems in its wake. These health problems followed those who were forced to flee the area. Federal officials fear that some of those problems may linger for years.
Not least of these problems is the enormous emotional toll of the disaster - one that is still testing Americans' resilience. And when Rita followed soon after, the problems got even worse.
And resilience is the only word to describe the survivors and doctors who shared their stories or blogs with WebMD.
9. Cloning - The Science Was Just the Beginning
Few scientific pursuits are more fraught with ethical issues than cloning.
On the one hand, medical researchers hope to clone stem cells, which hold the seemingly magical property of being able to transform into any cell of the body. The cells could be used to repair, replenish, or rejuvenate diseased or worn-out organs -- for example, by replacing lung cells.
This kind of cloning, called therapeutic cloning, isn't an ethical slam dunk. While adult stem cells can be cloned, there's still a need to learn from embryonic stem cells. And this raises ethical issues.
For example, Korean researcher Woo Suk Hwang in 2005 reported cloning the first human embryonic stem cells for a specific patient. But some of those cells came from eggs donated by women working as junior scientists in Hwang's lab - and they were reimbursed $1,445 for "direct expenses."
At the time, reimbursing egg donors was not illegal in Korea. As the year ends, Hwang's research is being called into question.
More controversial than therapeutic cloning is reproductive cloning.
This means implanting a cloned embryo into the womb of a living female, where it could become a fetus and, eventually, a baby. Scientists are nearly unanimous in rejecting human cloning as unethical. But it's not impossible to achieve. Hwang's Korean lab recently reported the birth of a puppy named Snuppy - the clone of an Afghan hound named Tai.
Therapeutic cloning isn't the same thing as reproductive cloning.
Confusion between the two is a problem, as lawmakers tend to tar therapeutic cloning with the brush of reproductive cloning. Polls show that most Americans favor the therapeutic use of embryonic stem cells.
And reproductive cloning of animals may have a future. The FDA is already mulling the question of whether to approve cloned animals for breeding and food purposes.
10. Soda Wars
As the national obesity problem continues to grow, so too does the quest to find a culprit that's causing it. Some of that blame, deserved or not, fell on the shoulder of soft drink manufacturers this year.
Lawsuits are in the works to go after "big soda," and one consumer advocacy group labeled soda "liquid candy."
Do sodas and other soft drinks make us fat? It's unfair to put all the blame for America's obesity epidemic on soft drinks. We gain weight more from what's on our plates than from what's in our glasses.
But there's good evidence that drinking just one or two soft drinks makes preschoolers put on weight, and there is increasing pressure to limit the amount of soft drinks sold in school vending machines.
Oddly enough, sweetened soft drinks aren't the only culprit. Diet soft drinks are linked to obesity, too. That's probably because diet drinks are an indicator for other overweight risks, although animal studies suggest diet drinks may increase appetite.
SOURCES: Bird Flu: WebMD Medical News, "Scientists in Desperate Race With Bird Flu," Sept. 28, 2005. WebMD Medical News, "Scientists: 1918 Killer Flu Was a Bird Flu," Oct. 5, 2005. WebMD Medical News, "Bird Flu Pandemic: Economic Disaster?" Dec. 8, 2005. WebMD Medical News, "Can States Pay for Bird Flu Preps?" Dec. 5, 2005. WebMD Medical Reference, "Bird Flu Time Line," Nov. 2, 2005. WebMD Medical News, "Bird Flu: 10 Questions, 10 Answers," Oct. 11, 2005. WebMD Commentary, " Bird Flu Facts and Fears, Oct. 31, 2005. WebMD Medical News, "Bird Flu Vaccine Works in Humans," Aug. 8, 2005. WebMD Special Report: Bird Flu. Terri Schiavo: WebMD Medical News, "End-of-Life Decisions: What Would You Want?" March 21, 2005. WebMD Medical News, "Schiavo Case Puts Living Wills in Spotlight," March 18, 2005. WebMD Medical News, "Eating Disorder Underlies Schiavo Tragedy," March 25, 2005. WebMD Medical News, "Are Americans Afraid to Talk About Dying?" March 23, 2005. Drug Warnings: WebMD Medical News, "New Pain Pills: Not Easier to Stomach?" Dec. 1, 2005. WebMD Medical News, "Painkiller Warnings Explained," April 7, 2005. WebMD Medical News, "Holes in U.S. Drug Safety Net," Dec. 5, 2005. WebMD Medical News, "FDA Issues Advisory on ADHD Drug Strattera," Sept. 29, 2005. WebMD Medical News, "Cancer Warning Suggested for Eczema Creams," Feb. 16, 2005. WebMD Medical News, "Deaths Prompt Abortion Pill Warning," July 20, 2005. Contraceptives: WebMD Medical News, "Sex Without a Safety Net," Jan. 5, 2005. WebMD Medical News, "Mis-Conceptions: Debunking Birth Control Myths," May 6, 2005. WebMD Medical News, "Warning Added to Birth Control Patch," Nov. 11, 2005. WebMD Medical News, "New Warning for Depo-Provera Users," Nov. 18, 2005. WebMD Medical News, "FDA Delays Decision on 'Morning After' Pill," Aug. 26, 2005. Tom Cruise: WebMD Medical News, "Psychiatrists Defend Psychiatric Drug Use," June 28, 2005. WebMD Feature, "Brooke Shields' Struggle With Postpartum Depression, from WebMD the Magazine," March 24, 2005. WebMD Medical News, "Essay Questions Role of Antidepressants," Nov. 7, 2005. WebMD Commentary, "Tom Cruise Plays Doctor," Sept. 1, 2005. Medicare: WebMD Medical News, "Medicare Drug Plan: Confusion Reigns," Nov. 10, 2005. WebMD Medical News, "Medicare Heading for Financial Crisis," March 23, 2005. WebMD Medical News, "Study Warns of High Rx Costs in Medicare," July 12, 2005. WebMD Medical News, "Report Urges Bargaining Power for Medicare," Sept. 27, 2005. Food Pyramid: WebMD Medical News, "Americans Get Diet Roadmap to Health," Jan. 12, 2005. WebMD Medical News, "New Food Pyramid Gets Personal," April 19, 2005. WebMD Medical News, "New Kid-Friendly Food Pyramid Launched," Sept. 28, 2005. Katrina and Rita: WebMD Medical News, "Hurricane Katrina: Health Aftermath," Aug. 31, 2005. WebMD Medical News, "Poll: Many Katrina Evacuees Face Health Woes," Sept. 16, 2005. WebMD Medical News, "Officials See Katrina Effects for Years to Come," Sept. 12, 2005. WebMD Medical News, "Americans Feel Katrina's Emotional Toll," Sept. 7, 2005. WebMD Feature, "9/11 to Katrina: America's Resilience Shines." WebMD Special Report: "Preparing for Rita." WebMD Medical News, "Katrina's Refugees: Facing Life Far From Home," Sept. 2, 2005. Real Stories from WebMD, "Katrina Shelter, The Full Story." Real Stories from WebMD "Hurricane Aftermath." Real Stories from WebMD, "The Way Home." Cloning: WebMD Medical News, "Stem Cells Used to Grow Lung Cells," Aug. 24, 2005. WebMD Medical News, "Korean Stem Cell Scientist Speaks Out," Dec. 16, 2005. Lee, B.C. Nature, Aug. 4, 2005; vol: 436 pp: 641. WebMD Medical News, "Survey: Most OK Embryonic Stem Cell Research," Oct. 14, 2005. WebMD Medical News, "Decision on Cloned Meat Expected Soon," June 28, 2005. Soda Wars: WebMD Medical News, "Soft Drinks: Scapegoat for Kids' Obesity?" May 11, 2005. WebMD Medical News, "Sweet Drinks Make Preschoolers Gain Weight," Feb. 7, 2005. WebMD Medical News, "Changes for School Drink Vending Machines?" Aug. 17, 2005. WebMD Medical News, "Drink More Diet Soda, Gain More Weight?" June 13, 2005.
By Daniel J. DeNoon
Michael W. Smith, MD© 2005, WebMD Inc. All rights reserved