Our A To Z Guide To Advances In Medicine

By Alice Park and David Bjerklie

ALZHEIMER'S

A nunnery might seem an odd place to conduct medical research, but some of the most intriguing advances in Alzheimer's last year came from studying a group of nuns who agreed six years ago to give their brains to science. A long-term study of 678 School Sisters of Notre Dame showed--surprisingly--that something as simple and non-medical as a handwritten missive, penned in youth, may be able to predict a person's chances of getting Alzheimer's later in life. That link is still quite controversial; less so are some of the study's other findings, such as the protection the brain apparently gets from higher education pursued in young adulthood or from engaging in constant mental activity like playing card games or teaching during one's golden years.

ARTIFICIAL HEART

The Tin Man traveled all the way to Oz for his heart, but someday patients with advanced cardiac disease may not have to go so far. Almost 20 years after the bulky Jarvik artificial heart failed so miserably, AbioMed, a Massachusetts-based bioengineering company, developed a new, miniaturized version called the AbioCor. The device, totally self-contained (except for a belt-worn battery pack), was implanted in six terminally ill patients; the first, Robert Tools, survived for five months, many months longer than his doctors dared hope. Doctors have had even more success with a small pump that takes over just one of the heart's chambers. (See LVAD.)

ALS

Amyotrophic lateral sclerosis, the paralyzing disease that took the life of Yankee great Lou Gehrig, is showing up in Gulf War veterans at twice the rate it occurs in other military personnel. That's the conclusion of the Defense Department and the Veterans Administration after reviewing the medical records of 2.5 million servicemen and women. ALS, which destroys nerve connections in the brain and spinal cord and causes muscles to atrophy, is the first disease directly linked to the generalized symptoms of Gulf War syndrome.

ASPIRIN

It's a painkiller, a blood thinner and a heart saver as well. But taking aspirin in combination with ibuprofen (in the form of Advil or Motrin) can render the multi-purpose pill powerless. Ibuprofen, it turns out, blocks aspirin's blood-thinning ability 98%; more studies are needed to determine whether people who take both drugs need to worry about a higher heart-attack risk. In the meantime, doctors note that aspirin does not cancel the effects of other major painkillers, including rofecoxib and acetominophen.

ASTHMA

Last July a Maryland woman participating in a Johns Hopkins Hospital study designed to better understand asthma inhaled an experimental chemical, developed a severe reaction and died. The government reacted swiftly: it shut down all federally funded human research at the hospital for four days. The death was only the latest in a series of mortalities in clinical trials and prompted Hopkins and hundreds of other institutions where human trials are conducted to scrutinize their procedures. Since then, hospital review boards have tightened their protocols for clinical trials, requiring that doctors be closely monitored and patients fully informed of the risks.

BAYCOL

Among the best-selling prescription drugs in the U.S. today are the statins--powerful medications that can lower cholesterol levels by as much as 30 points. A fix that quick comes at a price, however, as Baycol users learned this fall. The popular statin was pulled off the market after health officials discovered that a disturbing number of users were suffering from muscle disorders. Other statins, including atorvastatin, lovastatin and pravastatin, remain safe, according to the FDA.

BSE

The panic over bovine spongiform encephalopathy, commonly known as "mad cow" disease, spread all the way to Japan last year, where a handful of cases caused beef sales to plummet. The good news was that researchers using a mathematical model estimated that the brain-wasting BSE variant in humans may max out at 100 cases per year in Britain, ground zero for mad cow, and kill no more than a few thousand people in the coming decade. Feel any better?

BYPASS SURGERY

More than 500,000 bypass operations are performed in the U.S. each year, but what is good for the heart may not be good for the head. About a third of surgery patients, particularly those who are older and less educated, are at higher risk of cognitive decline after bypass surgery, according to a Duke University study. Doctors stress, however, that heart patients should not take this as an excuse to avoid needed surgery; it's not clear exactly how much of the mental fogginess is a direct result of the bypass operation and how much is a function of aging, medication or pre-existing cognitive problems.

CIPRO

Cipro was just another antibiotic used mostly for treating stubborn infections when it was catapulted to pharmaceutical stardom by the anthrax attacks. Cipro, it turned out, was the only antibiotic specifically approved by the FDA to treat anthrax, and suddenly it was the hottest drug in town. Doctors were besieged by patients demanding prescriptions "just in case," and pharmacies, particularly in New York, Washington and Florida, couldn't keep up. Other antibiotics, including doxycycline and that old standby penicillin, are just as effective against the particular strain that was showing up in tainted letters, and a few weeks later, when the cdc recommended that doctors switch to those, Cipro's days in the spotlight were over.

CLONING

Nobody cloned a human last year (at least so far as we know), but a Massachusetts biotech firm managed to create a stir nonetheless just by making a six-celled embryo from a human cell. The goal was to achieve what the company called therapeutic cloning, by which cells are coaxed into generating whatever replacement tissues or organs a patient might need. The House of Representatives, however, voted to ban all human-cloning research--including therapeutic cloning--out of concern that it might be the first step down a slippery slope to a world of Mini-Me's. The Senate put off debating the issue until later this year.

C.T. SCANS

Computed tomography is an invaluable tool for doctors, giving them an inside view of the body that can help spot appendicitis as well as cancer, pneumonia and other dangerous diseases before they become untreatable. But young children, whose growing cells are still dividing rapidly, may be at higher risk of developing brain cancer when exposed to the radiation of C.T. scans, according to a new study. The risk is small, but it can be reduced even further if technicians lower the dose for kids.

DEFIBRILLATORS

"A portable E.R. in the chest" is how Dick Cheney's doctor described the device he installed--along with a pacemaker, to keep the Veep's heart beating regularly--last July. Cheney, who suffered his fourth heart attack last year, may have to wear the business card-size device for the rest of his life. But should his heart ever act up again, the thing will automatically deliver a small jolt of electricity (enough to light a 30-watt bulb for 1 sec.) and snap it back into line.

DIABETES

Daily injections of insulin are not simply a pain in the butt. For diabetics, they are taxing and inconvenient reminders of their disease. Studies of inhaled insulins, in the form of oral and powdered sprays, suggest that they may be nearly as effective as injections are in quickly normalizing blood-sugar levels. While no injection-free insulins have yet been approved by the FDA, doctors--and their diabetic patients--are looking forward to the day when those hated needles can be replaced by inhalers.

FISH OIL

You've seen the "heart healthy" menu logo next to the fish entrees. Well, supersize that. Studies have shown that eating fish rich in omega-3 fatty acids (such as sardines, salmon and herring) not only protects you against heart disease but also cuts your risk of stroke. The more you eat, the greater the protection. And if that isn't enough to steer you to seafood, a 30-year study of 6,000 Swedish twins found that non-fish eaters are two to three times as likely to get prostate cancer. Go fish!

FLU

Flu season is a scary time for asthmatics. They believe--correctly--that the disease can be especially dangerous for them. But many also believe--incorrectly--that the flu shot itself can trigger an asthma attack, which is one of the reasons 9 out of 10 asthmatics pass on getting an annual flu shot. Those fears are misplaced, according to researchers who studied the risks and determined that the vaccine is safe for both children and adults--and who strongly recommend that America's 25 million asthmatics get a flu shot every year.

GAUR

Once scientists cloned run-of-the-mill livestock like Dolly the sheep, could exotic endangered species have been far behind? Meet Noah the gaur, the first endangered clone. The gaur is a species of wild ox that is fast disappearing from its native India and Burma. Noah started out as a skin cell on an adult gaur that was fused with an empty egg from an ordinary cow and then brought to term by another cow named Bessie. Scientists hope that similar operations will someday be a practical way to keep endangered species alive. Too late for Noah, however. He died from an infection two days after he was born.

GLEEVEC

There is still no cure for cancer, but drugs against the disease are getting a lot smarter. Instead of killing cells indiscriminately, as standard chemotherapy and radiation do, designer drugs such as Gleevec are engineered to block specific biological reactions that tumor cells--and not healthy ones--need to grow and thrive. Gleevec is currently approved to treat a form of leukemia and a rare stomach cancer. Close behind it in clinical trials is a string of experimental drugs that promise to do the same for other cancers, all with fewer side effects, so far, than current therapies.

GENETIC ENGINEERING

You wouldn't normally expect to find a jellyfish gene in a rhesus monkey, but ANDi is not just any monkey. He's the first primate to carry an artificially introduced snippet of DNA in every one of his cells. Scientists have been splicing genes in and out of lesser species for years, but this is the first time they've done it to such a close cousin of Homo sapiens. Their success with ANDi (whose name is a backward acronym for inserted DNA) suggests that they are closer to manipulating human cells to treat disease or--to choose a more controversial application--genetically enhancing individual humans and all their offspring.

HEART DISEASE

About half of heart attacks occur in people with normal cholesterol levels. So is that a reason to stop holding back on fatty foods? Before you reach for those French fries, better ask your doctor about your crps. There's growing evidence that in some people, inflammation (measured by the levels of so-called C-reactive protein present in the blood) is as important as cholesterol in determining the risk of heart attacks. The theory holds that the same aggravation by the immune system that seizes joints in arthritis may irritate heart arteries, making them more hospitable environments for fatty plaque deposits. Fortunately, the statins that work so well to lower cholesterol levels are also extremely effective at reducing CRP levels and, doctors hope, cutting the risk of heart attacks. More and more heart doctors routinely test levels of both cholesterol and CRP in their patients.

LOW-TAR CIGARETTES

If you can't kick the habit, you can at least minimize the damage by switching to an ultralight, low-tar brand, right? Sorry. A comprehensive National Cancer Institute study last year concluded that "light" smokes are every bit as bad for you as regular cigarettes. The report blasted the tobacco industry for deceptive marketing and called for a ban on the terms light, ultralight and low-tar.

LVAD

For desperately ill heart-disease patients, the implantable pump called the LVAD (left ventricular assist device) buys precious time while they wait for a donor with a heart to spare to turn up in a morgue. A kind of poor man's artificial heart that gives a boost to the heart's main pumping chamber, the LVAD can lengthen and improve the quality of life even in a patient with no prospect of a transplant. Once thought of as only a temporary solution, the LVAD may soon be playing a bigger role in long-term management of heart disease.

MAMMOGRAPHY

The logic of early detection seems hard to argue against; after all, the sooner you catch a cancer, the better your chances of nipping it in the bud. That's why for decades doctors have been recommending breast self-examination and annual mammograms for women over 40. But an analysis of several large studies late last year cast doubt on the conventional wisdom, suggesting that the presumed benefits of early detection were based on flawed studies. The American Cancer Society, however, was quick to point to other studies indicating that mammographic screening reduces mortality even more than previously thought.

MEMORY LOSS

Lost keys, confusion in the parking lot and more and more stories that start "Did I ever tell you...?" They may be harbingers of something serious like Alzheimer's. Or maybe not. What clinicians call "mild cognitive impairment" can be caused by trauma, depression or the side effects of medication. While not all cases of MCI lead inexorably to dementia, new studies suggest that a substantial number do. There are no drugs to prevent Alzheimer's, but there are treatments for MCI that can slow deterioration and preserve mental function a little longer.

MOUSEPOX VIRUS

It was an accidental discovery, but it could hardly be called serendipitous. By adding a single gene to its DNA, Australian researchers turned a mousepox virus that normally causes only mild symptoms in rodents into a virulent killer that wiped out all their lab mice in less than 10 days. Alarms were sounded, not over the prospect of mouse plague but out of concern that rogue scientists might use the technique to create human pathogens even more lethal than anthrax or smallpox.

OXYCONTIN

It seemed like the perfect drug, a time-released synthetic opiate that killed pain without making users high. But soon after OxyContin hit the market, sales became suspiciously brisk. Drug abusers had discovered that they could get a heroin-like buzz by crushing the pills before they took them. Almost overnight, OxyContin became the drug of choice on city streets and in the suburbs; it has now been linked to 300 deaths. As the drug skates between success and excess, the manufacturer has come under increased scrutiny for its aggressive marketing campaign.

OVARIAN CANCER

Aspirin, which can prevent everything from heart attacks to headaches, may also protect against cancer of the ovaries. A new study shows that women who took aspirin three or more times a week for at least six months had a 40% lower incidence of the most common type of ovarian cancer. The authors caution that the results are not yet conclusive. Aspirin also increases the risk of stroke and can cause gastrointestinal bleeding. Further studies will be needed to determine whether the benefits outweigh the risks.

RITALIN

Hailed as a wonder drug for the treatment of hyperactive children, Ritalin has also come under increased scrutiny from health professionals who are worried it is being overprescribed. New research suggests the drug may cause long-lasting changes in brain-cell structure and function similar to those seen with cocaine use. "Ritalin does appear to be safe when used properly," conclude researchers, "but it is still important to ask what it is doing in the brain."

STEM CELLS

Taken from embryos only days old, stem cells are nature's blank slates, capable of developing into any one of the more than 200 cell types found in the human body. Scientists hope these cells may someday be used to treat a range of degenerative diseases, including Alzheimer's, Parkinson's and diabetes. But using human embryos for research poses ethical problems, and until last year federal funding for such work was blocked. After much soul searching, President Bush decided last summer to allow federal grants for research that used only the 60 or so stem-cell lines that have already been established. Some scientists fear those 60 lines will not be adequate. Meanwhile, other scientists are making headway in turning adult cells into functional equivalents of embryonic stem cells, which, if successful, would neatly sidestep the controversy.

SMALLPOX

Just two decades after it was declared gone for good, this deadly scourge is back--in our fears if not in fact. Anthrax was bad enough, but smallpox in the hands of terrorists could make a far more devastating bioweapon. There is no effective treatment for the disease, and because routine vaccination was halted in 1972, even a single case could spread like wildfire. Officially, the only remaining sources of the virus are small quantities kept at two secure labs in the U.S. and Russia. Experts believe, however, that Iraq, North Korea and Russia may have secretly pursued weapons research that involved smallpox. Erring on the side of caution, the White House has ordered 300 million doses of the vaccine, enough for every man, woman and child in the U.S.

SECONDHAND SMOKE

Banishing smokers from offices, restaurants, malls and airplanes has been a big success--for nonsmokers anyway. The Centers for Disease Control reports that the levels of toxic chemicals produced in nonsmokers' blood by secondhand smoke have plunged more than 75% since they were last measured 10 years ago. That's great news, considering that secondhand smoke is blamed for thousands of cancer and heart-disease deaths each year.

TAMOXIFEN

Although a new class of drugs called aromatase inhibitors shows signs of being even more effective than tamoxifen at treating breast cancer, don't count the old drug out yet. Women who take tamoxifen might also be doing their hearts a favor. Though it's not clear what the mechanism is, tamoxifen appears to lower the incidence of cardiovascular disease, which kills 500,000 women each year, more than 10 times as many as breast cancer.

ZONE DIET

The lure of fast and easy weight loss is as enduring as young love. It is no surprise, then, that high-protein diets like the Zone, Atkins, Protein Power and Sugar Busters have seduced many a problem eater. Alas, there's no hard evidence that these diets deliver on their promise of sustained, long-term weight loss. In fact, the American Heart Association cautions, such regimens may do more damage than good by increasing fat consumption and reducing important sources of vitamins, minerals and fiber. Better to stick with the tried and true: exercise, portion control and a balanced diet. Not very sexy, but it may just work.