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Setbacks, Advances and Ghosts From the Past Marked 2002

HRT treatments stopped, malaria gene mapped, and smallpox fear returned

TUESDAY, Dec. 31, 2002 (HealthDayNews) -- Dangerous hormones. Killer mosquitoes. The threat of bioterrorists running amok. Even the return of a dangerous virus once thought banished from the planet.

The top medical news of 2002 was enough to bring a frown to our faces. However, that can be removed with a shot of Botox, which is now being dispensed at gatherings that have taken on the air of Tupperware parties.

It wasn't all bad news. Medicine found even more uses for statins, miracle drugs that not only reduce the threat of heart disease by lowering cholesterol but which have also been shown to be potentially effective against multiple sclerosis and Alzheimer's disease. And researchers found that a vaccine against a virus responsible for half of all cases of cervical cancer had a spotless success rate.

For women, though, the big medical story of the year broke when researchers pulled the plug on a nationwide study of health risks affecting postmenopausal women. The national study looked at the effects of hormone replacement therapy that was a combination of estrogen and progestin. However, the trial was cut short when those women taking the therapy were found to have significantly higher rates of stroke, breast cancer and cardiovascular disease. Some physicians said they thought that while estrogen itself provided some protection, the particular type of progestin used may have counteracted its benefits.

In another blow to a potential treatment for a growing health problem, the Irish pharmaceutical company Elan suspended a trial of an experimental vaccine against Alzheimer's disease after injections caused severe brain inflammation in study volunteers. Earlier tests on mice had suggested the vaccine might slow or prevent development of the dementia disease.

Such is the nature of medical research -- one step forward, two steps back. One of the more promising developments was the success rate of the vaccine against HPV-16, the variety of human papillomavirus that infects some 20 percent of women. HPV-16 is also the strain most commonly linked to cervical cancer, and is present in 50 percent of all such cancers. Scientists say they see the day when teenaged girls can get the vaccine to protect against future disease.

Even more exciting was the range of studies last year that continued to document the efficacy of statins. Now used routinely to lower so-called "bad" LDL cholesterol, studies are now finding potential new uses for the drugs. One Austrian study found laboratory results from test tubes and animals showed statins worked in a similar fashion to interferon by forming substances that modulated immune system responses. The effects were even greater when statins were combined with interferon, which was a help to people with multiple sclerosis.

In yet another plus for statins, patients who had balloon angioplasty and received a statin after the artery-widening procedure had a 20 percent lower rate of heart attacks and other major cardiovascular events afterwards. Medical researchers are beginning to explore the possibility that statins' powers extend beyond their ability to dramatically lower cholesterol levels, primarily through the reduction of inflammation.

The connection between heart disease and inflammation in the body is also at the heart of new research into the predictive value of the C-reactive protein (CRP) test. In a groundbreaking study involving women, it was found that those with high blood levels of CRP were more likely to suffer a "cardiovascular event" than those with high levels of LDL cholesterol. Perhaps more significantly, three quarters of the women who suffered some form of heart problem did so even if their LDL levels were below that which is regarded as dangerous. The study gave a huge boost to proponents of the relatively inexpensive blood test, which until now has not been commonly given to otherwise healthy people.

No matter how good one's health is, though, it is difficult to imagine anything scarier than the presence of terrorists using deadly germs as weapons. This is the great fear that faces American troops poised in the Persian Gulf, awaiting orders from President Bush to remove Iraqi leader Saddam Hussein from power. Bush has ordered military and emergency personnel to be given the smallpox vaccine, but some medical authorities question whether the general population needs to be immunized against the virus.

For now, the White House is making the decision on whether to vaccinate the entire population a voluntary one, with vaccines not expected to be widely available until 2004. Though the vaccine is effective against smallpox, a very small percentage of those who receive it do suffer serious side effects. Still, in a poll conducted by the Robert Wood Johnson foundation, two-thirds of those asked said they would line up to receive a shot.

While the threat of a smallpox outbreak on American soil seems remote, the presence of another deadly virus is growing.

The U.S. Centers for Disease Control and Prevention reported at year-end there were 3,389 cases of West Nile virus transmitted to humans via mosquito bites in 2002, compared with 149 cases between 1999 and 2001. Deaths from the virus, meanwhile, rose to 201 in 2002 and, in what is believed to be a first, health officials suspect a pregnant woman in upstate New York passed West Nile virus onto her unborn child, apparently leading to serious birth defects.

In some good news regarding man's perennial battle with the pesky mosquito, scientists did map out the genetic code of both the chief malaria parasite and the mosquito that is the most frequent delivery method of the deadly infection into humans. While there are drugs for malaria, the most common ones are 50 to 2,000 years old, and resistance to these treatments is growing. The genetic development could lead to better treatments and newer vaccines for malaria. One day, man might win the last round against the mosquito.

Perhaps not as earth-shattering as new vaccines and powerful heart drugs, last year also bore witness to the transformation of a toxin into an all-purpose fix for several health problems.

The U.S. Food and Drug Administration (FDA) gave its approval to the use of Botox, the brand name of a purified form of a protein called botulinum toxin type A, for cosmetic uses such as smoothing facial wrinkles. Additional uses could include giving Botox for migraines and reducing spasticity in patients suffering from strokes. However, in a bow to the neverending vanity of aging baby boomers, the toxin's most popular use remained cosmetic. Botox parties became the rage, as women lined up by the hundreds for a glass of wine with their wrinkle treatments.

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