The Year In Medicine From A To Z

(11 of 12)

Though they happen in the brain, strokes are a lot like heart attacks; the same risk factors that lead to a coronary can increase the risk of a clot-based stroke. One common factor, which doubles the risk of stroke, is metabolic syndrome, a condition marked by such abnormalities as high levels of glucose and triglycerides, low levels of good cholesterol, and high blood pressure. Being overweight is another, according to Swedish scientists, who found that heavy middle-aged men had twice the risk of a stroke. Not surprisingly, cholesterol-lowering statins developed for heart patients also work for stroke victims, lowering their risk of cognitive impairment.

T

TUBERCULOSIS

If Americans think about TB at all, it is usually only in fearful association with drug addicts, the homeless or prison inmates. It is easy to forget that within living memory, tuberculosis was a major public-health problem in this country. Researchers, realizing that drug-resistant varieties are emerging from inadequate treatment both here and in other parts of the world, have launched the first North American vaccine trial in 60 years, using new formulas created with recombinant DNA technology. The results of the trial are eagerly awaited by public-health workers in the developing world, where TB kills nearly 2 million people each year.

V

VACCINES

Unlike most sexually transmitted infections, human papillomavirus (HPV) typically runs its course without causing illness. Fully half of U.S. adults have been infected without even knowing it. But in a small percentage of cases, the disease progresses to cervical cancer, which kills 4,000 women in the U.S. and 250,000 worldwide each year. Researchers have developed a vaccine that appears to be 100% effective against the two strains of HPV that cause 70% of cervical cancers. The vaccine may be available next year, but is likely to cause controversy if, as expected, it is recommended for girls before they become sexually active.

VIOXX

The first hints that the pain reliever Vioxx might raise the risk of heart attacks and stroke surfaced in 2000, but it still came as a shock when drugmaker Merck announced in October that it was pulling its blockbuster drug off the market. Safety data from an ongoing trial had produced clear evidence of cardiovascular problems in subjects taking Vioxx--so clear that the trial was immediately halted.

Vioxx is one in a new class of drugs called COX-2 inhibitors, which were designed to be safer for treating arthritis pain than over-the-counter remedies like aspirin, ibuprofen and naproxen. Concerns have been raised about another member of the group, Pfizer's Bextra. The safety of Celebrex, the most popular of the COX-2 drugs, will be reviewed in the coming months.

The benefits of COX-2 inhibitors are real, but millions of patients are left wondering whether they were prescribed the new pills because they were better than older and cheaper drugs or because they were backed by multimillion-dollar marketing campaigns.

VISION