The past year has seen a wide variety of health-related headlines - the terrorist threat of smallpox infection, a new caution about hormone replacement for menopausal women, and advances in gene therapy and cardiac care, to name a few. Here are the Harvard Medical School Faculty's picks for the Top Ten health/medical stories of 2002.

1. The Limits Of Hormone-Replacement Therapy

Many women were profoundly affected by the finding that combination estrogen and progesterone therapy (HRT) for menopausal women carried more risks and less long-term benefits than realized. It has been replaced with a better understanding of how short-term HRT still can be used to treat menopausal symptoms, while most women should avoid long-term HRT for disease prevention.

2. Walter Willett's Healthy Eating Pyramid

Substituting carbohydrates for fats isn't working. Despite fewer fats in our foods, Americans are getting heavier and heavier. New evidence supports changing focus: Limit total calories, exercise every day, eat as many vegetables as you want, use monounsaturated and polyunsaturated oils, and stay away from trans fats and saturated fats.

3. Smallpox Vaccine

The year marked the 25th anniversary of the global eradication of smallpox as a naturally occurring disease, but also the first year since 1972 that the vaccine was recommended for U.S. civilians.

4. C-Reactive Protein Test Holds Promise In Cholesterol Screening

A simple, inexpensive blood test to measure C-reactive protein (CRP) seems on the verge of becoming a routine screening test to help doctors and patients figure out who has an increased risk of heart disease - and therefore might benefit from use of statin therapy to lower cholesterol. Research in 2002 indicated that CRP levels might be an even better screening test than LDL cholesterol.

5. Global Fund To Fight AIDS, TB, And Malaria

The Global Fund to Fight AIDS, Tuberculosis, and Malaria, proposed by United Nations Secretary General Kofi Annan, received $2.1 billion in pledges, and began disbursing funds to assist impoverished countries in overcoming these three diseases of poverty, which together account for nearly 6 million deaths per year.

6. Increasing Rate Of Type 2 Diabetes In Children

With the rise in obesity rates, type 2 diabetes (formerly called adult-onset diabetes or non-insulin-dependent diabetes) is reaching epidemic proportions with younger and younger people being affected. If this trend continues, type 2 diabetes could become more common in children than type 1 diabetes (insulin dependent diabetes).

7. Diuretics Are Best, Cheapest Treatment For High Blood Pressure

Thiazide type diuretics (chlorthalidone and hydrochlorothiazide) are clearly the drug class of choice when a person needs drug treatment for high blood pressure.

8. Drug-Coated Stents Revolutionize Cardiac Care

Sometime early in 2003, many if not most coronary angioplasties throughout the United States will be performed using wire stents coated with drugs that reduce the rate of recurrence of artery narrowings to nearly zero. Many experts believe this innovation will transform care for people with coronary disease, leading to lower risks for heart attacks.

9. Research Proves Some Alternative Therapies Effective

Scientific research on complementary and alternative medicine is increasingly found in high-profile medical journals. Evidence has emerged suggesting the effectiveness of some therapies, such as saw palmetto for enlarged prostate, ginkgo for some types of dementia or claudication (leg pain caused by artery narrowing), glucosamine for knee osteoarthritis, and garlic for mild cholesterol reduction. Studies continue in these areas, often with financial support from the U.S. National Institutes of Health. There is also rising awareness of dangers of some herbs and supplements, such as possible liver problems from kava, contamination of products such as PC-SPES, and potentially serious drug interactions with St. John's wort.

10. First Successful Gene Therapy For Immune Deficiency

Gene therapy has proved generally disappointing. However, in 2002 a research team successfully accomplished gene therapy in patients with a rare, severe immune system defect caused by mutation in a single gene. The research team extracted stem cells from the patients' blood, introduced the healthy version of the defective gene into those cells, grew the cells in large numbers outside the body, and then injected them back into the patients, leading to a new immune system without the disease-producing genetic defect - all without any side effect.

Drug diluting Pharmacist Gets 30 years in prison

A US District Judge had imposed the maximum sentence of 39 years on a pharmacist who pleaded guilty to 20 counts of misbranding, tampering with or adulterating chemotherapy drugs The case drew worldwide attention and prompted actions on both state and federal levels aimed at more tightly regulating pharmacists after an FBI investigation led to the pharmacist's arrest in August 2001. The pharmacist, considered a specialist in mixing chemotherapy treatments, eventually admitted to diluting drugs for nearly a decade in order to pocket higher profits. The scheme is thought to have affected possibly 4,200 patients.

Miltefosine, An Oral Drug, for Leishmaniasis (Kala Azar)

In Bihar among the 83 million residents who are among the poorest and least educated people in the country, as many as 200,000 deaths from visceral leishmaniasis occur each year. This infectious disease is transmitted by the bite of a sandfly. For decades, treatment with injected pentavalent antimony was effective, but the parasite in Bihar has developed resistance, rendering this approach nearly useless. The second-line edication, conventional amphotericin B, can require a month of intravenous infusions and carries a risk of renal toxicity. Short-course treatment with lipid formulations of amphotericin B is highly effective but is financially out of reach in Bihar.

In the mid-1990s, miltefosine was shown to have activity against leishmania in vitro and in animal models. Researchers in Bihar began working with a company that had developed miltefosine as an anticancer drug. But no one was certain whether adequate support would be available to develop this drug for use almost exclusively in impoverished populations. In 1995, Tropical Disease Research (TDR), a program sponsored by the World Health Organization and other international groups, and the company now known as Asta Medica-Zentaris entered into an agreement to develop miltefosine for visceral leishmaniasis in India

The results with miltefosine, at each stage of research, surprised even the investigators. At the doses that are needed to be effective against visceral leishmaniasis, oral miltefosine had less general toxicity. Planning is under way for a phase 4 trial. Miltefosine is imperfect: it cannot be used in pregnant women. This drug has the potential to revolutionize treatment of visceral and perhaps other leishmanial syndromes, especially in the impoverished regions where leishmaniasis typically occurs."

Vampire-bat Saliva May Hold Stroke Treatment

An enzyme that helps vampire bats suck blood could turn out to be a treatment for strokes caused by blood clots, early research suggests. The substance, called Desmodus rotundus salivary plasminogen activator (DSPA), is a natural clot-dissolver that vampire bats secrete when they sink their teeth into their victims--allowing better feeding. DSPA is also genetically similar to the human clot-busting substance, tissue plasminogen activator, or tPA. An engineered version of tPA is used to treat heart attacks and strokes caused by blood clots. However, tPA must be used within 3 hours of stroke onset, and there is some evidence from animal studies that the drug can promote brain cell damage--although this remains controversial. According to the authors of the new study, performed in mice, their findings suggest that the bat-derived DSPA could treat stroke without harming brain cells. They also speculate that the salivary substance could be used during a larger window of time than tPA is. ( SOURCE: Stroke 2003;10.1161/01.STR.0000049764.49162.76. )

Viagra can cause blood clots, heart attack

The drug Viagra appears to stimulate the formation of blood clots, which could explain the heart attacks and strokes experienced by some men taking the erectile dysfunction drug, scientists said. "We found that Viagra actually has a stimulatory role in ... clumping platelets, which is important in causing heart attacks and strokes," Dr. Xiaoping Du, the study's lead author and an associate professor of pharmacology at the University of Illinois at Chicago's College of Medicine, told United Press International. Platelets are blood components that help form blood clots and repair damaged blood vessels.

This was surprising, Du said, because "originally this drug was designed to ... prevent heart attack." . The findings indicate Viagra is safe for healthy men, Du said. "This drug by itself cannot cause (clots in blood vessels and the heart) but it promotes (clots) when the patient already has a precondition" such as blocked or damaged arteries, he said. "And that explains why for most people it's OK but some people die," he added.

Folic Acid deficiency Tied to Colon Cancer Risk

A diet containing little alcohol that is rich in folate sources like green leafy vegetables, fruits and whole grains may lower the risk for colorectal cancer, according to researchers in Italy. In a study of 1,953 patients with colorectal cancer and more than 4,000 disease-free patients, researchers found an association between the amount of folate in the diet and the risk of cancer. Dr. Carlo La Vecchia, the study's lead author, said the incidence of the disease was 40% higher for patients who were heavy drinkers and had diets deficient in folate and the essential amino acid methionine. The main public health message from this study is that people should "avoid drinking more than one or two drinks of alcoholic beverages a day," exercise regularly, and eat a balanced diet with "lots of fruits and vegetables." ( SOURCE: International Journal of Cancer 2002;102:545-547. )

Therapeutic AIDS Vaccine Said Promising

In the study, researchers from the Universite Rene Descartes in Paris used rare white blood cells called dendritic cells to house inactivated simian immunodeficiency virus (SIV), which is similar to human immunodeficiency virus (HIV). Dendritic cells strongly activate the immune system, and are being looked at by many scientists for vaccines and therapies. The French researchers took dendritic cells out of 20 SIV-infected rhesus monkeys, mixed them in a test tube with chemically inactivated SIV, and then reinfused the mixture into the monkeys three times at two-week intervals. The monkeys had a strong immune response, marked by a decrease in SIV viral levels in their blood and immune systems, and an increase in CD4 cells, a measure of immune-system health. It is the first time anyone has shown that the cells could be used this way against SIV, which is used as a model for HIV. . Overall, the study is a good "proof of principle," that will encourage others exploring the use of dendritic cells as AIDS vaccines.

Compiled from WWW by Dr. Venkat Appaji Padmanabhuni

email : appajipv@hotmail.com