A to Z Guide

By David Bjerklie, Alice Park and Sora Song

ALZHEIMER'S

New estimates show that by 2050, a record 13.2 million older Americans will be affected by the progressive brain disease, 3 million more than previous projections. Although the illness is still definitively diagnosed only at autopsy, advances are being made in finding it earlier. Doctors can improve the accuracy of detection 30% by combining various cognitive tests with positron-emission tomography (PET). PET is an imaging technique that shows the brain's metabolism at work. Preliminary research suggests that it may also be possible for physicians to detect certain telltale signs of Alzheimer's disease--the so-called amyloid and tau proteins--in the spinal fluid.

Of course, knowing you have early Alzheimer's doesn't help much if it can't be treated. Fortunately, therapies are improving. Exelon and memantine, drugs usually used to treat the symptoms of dementia in moderate cases of Alzheimer's, may be even more useful in delaying the progression of early disease.

Neuroscientists were disappointed two years ago when a potential vaccine for Alzheimer's disease ended up causing severe inflammation of the brain. (One woman died several months after being vaccinated. Further study confirmed that her brain was inflamed, though some of her brain plaques, a symptom of Alzheimer's, seem to have shrunk.) Doctors are making progress toward finding ways to avoid the inflammation.

AIDS

AIDS is still a death sentence in much of world, so President Bush pledged $15 billion over the next five years for the relief of the disease in the most severely affected nations of Africa and the Caribbean. At least $10 billion a year is needed, according to U.N. estimates, but the world's richest countries spend a total of about $2.8 billion annually.

In the U.S., experts reported that for the first time since the mid-1990s, the number of HIV infections rose, by 1%. They believe some of the climb can be traced to the fact that more and more HIV patients are living longer, thanks to a potent combination of drugs that can control the virus. Unfortunately, if survivors fail to follow prevention guidelines, they may pass HIV along to others.

There were disappointing results on the research front as well. Scientists found that some anti-AIDS therapies seem to increase the risk of heart attack 25%, at least in the first few years of treatment. In addition, studies showed that taking a break--or "drug holiday"--from the grueling pill-popping schedule does not improve the body's ability to overcome drug-resistant forms of HIV.

The first vaccine to be widely tested in humans failed to protect test subjects from HIV. But the information gained should help in the development of future vaccines.

ANTIBIOTICS

Babies who are 6 months old or younger face a risk when given antibiotics for the first time. A Detroit study found that such infants were 1 1/2 times as likely to develop allergies and twice as likely to develop asthma as babies who didn't take the drugs. But exposure to dander from two or more household pets seems to reduce these risks.

McDonald's, the world's largest fast-food chain, said that by the end of 2004 it would stop using meat from animals that had been excessively treated with antibiotics. The decision may help curtail the practice of dosing healthy animals with antibiotics to plump them up for slaughter. Doctors hope this will reduce the opportunity for disease-causing bacteria, present in meat, to become resistant to drugs.

BERRIES

Better aim your grocery cart toward the fruit aisle. Studies in animals hint that berries are bursting with benefits. For one thing, they are chock-full of antioxidants, which help absorb some of the toxic molecules called free radicals that the body produces during metabolism. Cranberries may pack a one-two punch. They seem to boost levels of HDL, the so-called good cholesterol, which soaks up artery-clogging fat. They may also reduce the amount of damage to the brain that occurs after a stroke. Blueberries appear to lower the risk of heart disease by keeping arteries elastic and making them less prone to wear and tear when the body is under stress.

BLOOD PRESSURE

The National Heart, Lung and Blood Institute changed its guidelines last year. What it used to call a "high normal" level--from 120/80 mm Hg to 139/89 mm Hg--is now considered prehypertensive. The move should prompt more people to lower their salt intake and exercise, both ways to avoid high blood pressure.

BIRTH CONTROL

Women in the U.S. are a step closer to getting emergency contraception without the need for a doctor's prescription. An advisory panel of the Food and Drug Administration (FDA) recommended that the morning-after pill become available over the counter. If approved, Plan B, as the two-pill regimen would be called, would enable women to end pregnancies within 72 hours of unprotected intercourse.

CANCER

BREAST: A group of drugs called aromatase inhibitors that were once used to treat metastatic breast cancer is helpful in less advanced cases as well. They target tumors that need estrogen by lowering the amount of estrogen in the body. Women who took aromatase inhibitors for five years after taking tamoxifen (which also shrinks estrogen-sensitive tumors) reduced their risk of recurrence by almost half.

COLON: There's a good alternative to the dreaded colonoscopy. Tests showed that virtual colonoscopy, which images the colon by combining C.T. scans, can be as reliable at detecting tumors--provided the right 3-D software is used. And in the first trial of its kind, Avastin, a drug designed to starve a tumor by cutting off its blood supply, showed promise against colon cancer when used in conjunction with chemotherapy. Doctors are exploring its use against other solid tumors.

PROSTATE: About 75% of men in the U.S. over 50 have been screened for prostate cancer with the prostate-specific antigen (PSA) test, but the threshold level that doctors use to biopsy suspicious growths misses up to 82% of cancers. Harvard researchers reported that lowering the PSA level at which doctors recommend biopsies could double the rate at which they detect cancers.

LUNG: Most cases of lung cancer are too advanced for treatment by the time they are detected, but researchers at Duke University are working on a blood test that could detect the disease in its earliest stages, when the cancer may still be treatable. Their aim is to detect traces of a protein, called serum amyloid A, that is elevated in cancer patients but not in healthy people.

CHOCOLATE

Sweet news: besides tasting great, chocolate can do you some good. It's rich in flavonoids, which can raise levels of good cholesterol, and antioxidants, which limit cell damage. Heating chocolate seems to release antioxidants, so go for the hot cocoa. Not all chocolate is created equal, however. Dark chocolate is more potent than its paler cousin in raising antioxidant levels, possibly because the milk in milk chocolate binds to antioxidants. In addition, German research comparing dark and white chocolate found that the dark stuff can lower blood pressure.

DIABETES

Expanding waistlines continue to feed the epidemic. Doctors hope that by shifting their attention to prediabetes--a condition that significantly increases the risk of Type 2 diabetes, the most common form of the illness--they can reduce the number of folks who develop full-blown diabetes and such devastating complications as heart and kidney trouble, strokes and blindness.

The American Diabetes Association broadened the definition of prediabetes to include those with fasting blood-sugar levels of 100 mg/dL (it had been 110 mg/dL).

Because diabetics face fewer complications if they avoid hypertension, the American College of Physicians now recommends that diabetics keep their blood pressure below 135/80 mm Hg.

DIET

Another scattering of studies showed that the low-carb Atkins diet really does melt the pounds away--at least in the short run. Subjects in two trials ate either a low-carb diet or a conventional low-calorie, high-carb menu. At the end of six months, the carb cutters lost twice as many pounds as the calorie counters. The pounds, however, quickly reappeared after the first part of the study was completed. By the end of the next six months, the two test groups showed no difference in the amount of weight they had lost. The studies also found that those who ate the low-carb way enjoyed higher levels of HDL, but it's not yet clear whether this boost provides enough of a benefit to the heart to compensate for the extra fat consumed in the Atkins-style diets.

EPHEDRA

Since 1997 the FDA has been keeping track of ephedra, an herb used in dietary supplements for weight loss and energy boosts. Last month the agency finally amassed enough data on the herb's side effects--from high blood pressure to stroke and sudden death--to justify a proposed ban of the supplement. The move comes too late for the Baltimore Orioles' Steve Bechler, who died during spring training after taking the supplement. But health officials expect that a ban will save other lives.

ELECTRON-BEAM COMPUTED TOMOGRAPHY

Much as heart doctors know about the risk factors that contribute to heart disease--high cholesterol, high blood pressure, stress and lack of physical activity--they still have no reliable way to predict who will and who won't suffer a heart attack.

Until now. It turns out that excess deposits of calcium in the lining of the arteries, which can be measured using electron-beam computed tomography (EBCT), are a good indication that potentially dangerous fatty plaques exist. The correlation is strong enough that the American Heart Association is weighing a recommendation of EBCT screening for healthy adults who have a greater than average risk of heart disease, including smokers and those with a strong family history. As an added benefit, patients can take home their EBCT image, complete with gummed-up arteries, and use it as a reminder to stick with that exercise program and low-fat diet.

FLU

It was a flu season to remember, but not because it was a historically bad one. Rather, it was because the annual ordeal started earlier than usual, took the lives of nearly 100 youngsters and raised concerns that the supply of vaccine couldn't meet demand and might not be effective against this year's strain of virus. At the same time, health officials urged that all healthy babies between the ages of 6 months and 23 months be vaccinated. Thankfully, the worries proved to be overblown, but as experts at the Centers for Disease Control and Prevention (CDC) pointed out, when it comes to the flu, it's far better to be safe than sorry.

GREEN TEA

How healthful is a cup of green tea? Let us count the ways. Recent studies suggest that chemically active compounds in the soothing drink may help lower cholesterol, aid the immune system in fighting off infections, assist in weight loss and protect against cancers of the lung, colon, breast, liver, prostate, pancreas, bladder and skin. Tea may also help us prevent diabetes and bad breath. Keep in mind, though, that the studies are preliminary and sometimes even contradictory. Enjoy your cup of tea, but don't expect it to be a cure-all.

HRT

Last year put a few more nails in the coffin of long-term hormone-replacement therapy. Further examination of the data from the Women's Health Initiative, a study that involved more than 16,000 women, showed that the combination of estrogen and progestin not only raised a postmenopausal woman's risk of heart disease and breast cancer but also increased her risk of stroke and doubled her chances of developing dementia if she was 65 or older. The grim research results, on top of those released in 2002, have translated into plummeting prescriptions for Wyeth Pharmaceuticals, manufacturer of Prempro (the company also helped fund the critical studies): the tally of 2003 sales of the hormone combo is expected to be down 50% from 2002 sales, which were down 25% from 2001 sales.

HEART

The news reports dubbed it "Drano for the heart," and if the results are confirmed in larger trials, they may signal an exciting new approach in fighting cardiovascular disease, America's leading cause of death. "It" is a genetically rare type of HDL, or "good" cholesterol, dubbed ApoA-1 Milano. First identified 30 years ago in a small group of people living in northern Italy, this super HDL is even more protective against heart disease than regular HDL. In a study released this past fall, researchers injected a synthetic version of ApoA-1 Milano into 47 patients and found that unlike drugs that merely slow the dangerous buildup of plaque in the arteries, super HDL reduced the size of the plaques--and did so in the dramatically short period of five weeks. The experimental drug also stabilized the plaques that remained and reduced their level of inflammation, making them less likely to burst. Though the study was too small to be definitive, it certainly stirred a lot of interest at the American Heart Association's meeting in November. After years of being preoccupied with lowering levels of LDL, the "bad" cholesterol, doctors and patients may soon be focusing on how to pump up vessel-cleansing HDL.

INSOMNIA

The value of a good night's sleep is hard to overstate. And researchers are increasingly finding that sleep doesn't just improve the quality of life--it actually prolongs life as well. An analysis of eight sleep studies showed that healthy adults age 60 and older who experienced poor sleep--characterized by long stretches of wakefulness during the night--had double the normal risk of early death. Other studies link poor sleep to lower immune-system function as well as an increased risk for certain types of cancer.

But to what lengths should you go to make sure you get enough sleep? Today's sleeping pills can help, but are they safe to take in the long term? The drug company Sepracor has been testing a new pill, Estorra, that appears to be both safe and effective when taken for six months. The drug is under review for approval by the FDA. No doubt competitors will be looking at their own sleep drugs to see if they can pass the six-month test.

LEAD

Lead poisoning doesn't seem like much of a problem these days, but new research gives fresh cause for concern. It seems that blood levels of lead previously thought to be safe can actually cause intellectual impairment. Not only that, but quite a bit of damage seems to occur at low levels of exposure. A five-year study found that kids with a blood-lead level at the acceptable threshold of 10 micrograms per deciliter (mcg/dl) scored seven points lower on an IQ test than kids with a level of only 1 mcg/dl. The guidelines for safe lead levels have been revised repeatedly over the years, from 60 mcg/dl before 1970 to 25 mcg/dl in 1985 to 10 mcg/dl. They may have to change again. The CDC estimates that 1 in 10 children under age 6 has a blood level of 5 mcg/dl or higher.

LONGEVITY

Various studies have shown that identical twins live longer than fraternal twins. Researchers think they know why: communication. Identical twins appear to keep in touch by phone or mail more often; such social support is known to improve health. The extra bit of close contact translated into a median life-span of 82 years vs. 80.5 years for fraternal twins.

MAD COW

Word came just two days before Christmas that the dreaded disease, formally known as bovine spongiform encephalopathy (BSE), had arrived in the U.S. Tests confirmed that a 6-year-old dairy cow, which had been ground into hamburger two weeks earlier, was a carrier. Although the cow had entered the U.S. from Canada in 2001, more than 30 countries quickly banned U.S. beef imports. The U.S. Department of Agriculture in turn recalled 10,000 lbs. of ground beef and instituted a series of measures to reassure consumers, including a ban on the slaughter of cattle too sick or injured to walk. The cow in question was born a few months before a ban on feeding cattle the pulverized remains of their kin, the most likely path of infection, went into effect in Canada and the U.S. Only 20,000 of the 35 million cattle slaughtered in the U.S. each year are tested for BSE.

OBESITY

What will it take to get our attention? Obesity accounts for 280,000 deaths in the U.S. each year. If current trends continue, the battle of the bulge will overtake smoking as the primary cause of preventable death. Some researchers believe that today's wide-bodied kids will have shorter life-spans than their parents.

The number of overweight kids has tripled in the past 20 years, and some two-thirds of American adults are either overweight or obese. Sure, stomach stapling is all the rage--100,000 operations last year--but the costly, risky procedure is no answer for the massive masses.

Meanwhile, the search is on for a magic pill. One study found that a natural compound called PYY reduces appetite and food intake when given to test subjects intravenously. Another study found that a natural fatty acid, OEA (oleylethanolamide), also seems to regulate hunger and metabolism--at least in mice. Research on both compounds is still in the early stages, but they could be the basis for new treatments targeting obesity. What to do until these wonder drugs arrive at the local pharmacy? Yep. Eat less, and exercise more.

PARKINSON'S

The quaking, shaking symptoms of this degenerative disease, which afflicts 1.5 million Americans, have been notoriously tough to treat. For 40 years, efforts have focused on drugs that regulate the function of a key neurotransmitter called dopamine. Now attention is shifting. Doctors have begun implanting electrodes on both sides of the brain to stimulate its inner regions--an approach that has shown some success in treating intractable epilepsy.

And a drug unrelated to dopamine, istradefylline, seems to reduce tremors and slowness in Parkinson's patients with advanced disease.

Given that the condition can only be slowed, not cured, prevention may be the best bet. A long-term study of 140,000 adults suggests that regular use of nonaspirin painkillers such as Motrin or Aleve may offer some protection. Another prevention strategy is to avoid head injuries. Studies have shown that individuals who have experienced a head injury serious enough to require hospitalization have an eightfold higher risk of suffering from Parkinson's disease later in life.

PAXIL

A group of antidepressants called SSRIs may be doing wonders to lift moods in adults, but concern is growing over their use in teens and kids. First, researchers in Britain found that youngsters taking Paxil were more likely to have suicidal thoughts. Regulators there decided the drug should not be given to children. In the U.S. the FDA quickly followed suit. Six months later, the British regulators warned against the use of five other antidepressants in young people. Doctors on both sides of the pond still think that Prozac is O.K., but expect the U.S. to take a closer look at all other SSRIs.

SARS

The first reports of an unusual and severe form of pneumonia came in February, from doctors in Hong Kong. In March, the brand-new disease SARS--severe acute respiratory syndrome--claimed its first victim in the island city. Soon SARS was suspected to have infected more than 7,600 people in 30 countries, including Taiwan, Canada and the U.S. Travel was restricted, schools were shut down, and panicked residents of hard-hit countries wore masks outside their homes if they went out at all. But by April, with a swiftness the World Health Organization called stunning, scientists had identified the novel virus at the root of SARS--a member of the coronavirus family, which usually causes nothing more than a bad cold--and sequenced the new pathogen's genome. Chinese health officials were roundly criticized when it became clear that the bug had actually made its first appearance late in 2002 in the southern Chinese province of Guangdong; a more timely alert might have helped stem its spread. By year's end, U.S. researchers had successfully tested an experimental SARS vaccine in monkeys.

SMALLPOX

Although smallpox was declared eradicated in 1980, the U.S. government remains concerned that stocks of the virus might fall into terrorist hands and be unleashed on the public. To counter that scenario, federal scientists are testing a new generation of safer vaccines (the old one is the most lethal vaccine around, killing an estimated one or two of every million who take it) and helping to fund a multimillion-dollar effort to create a pill to treat and possibly prevent infection. The Bush Administration last year offered a version of the old vaccine, on a voluntary basis, to key civilian health-care workers. The initiative ground to a halt in June after just 38,000 of the 500,000 intended subjects were inoculated. There just weren't enough doctors and nurses willing to risk a potentially fatal reaction.

SMOKING

Cigarettes are still bad for you, and it's still as hard as ever to quit. But researchers have found two more good reasons--particularly for women--to tough it out. A study of 3,000 smokers, ages 40 years and older, showed that female smokers had twice the risk of lung cancer as their male counterparts, independent of age or the amount they smoked. Further, in a separate study of 5,300 smokers, scientists found that giving up cigarettes benefits women more than men. In the first year after quitting, the women's lung function improved more than twice as much as the men's, and it stayed better throughout the five-year study.

TRANS-FATTY ACIDS

There's fat, and then there's trans fat (e.g., "hydrogenated" oils)--also known as trans-fatty acids. Food manufacturers began using them in place of saturated fats in the 1980s. Trans fats extended the shelf life of certain products, and foodmakers thought they made edibles safer. Turns out trans fats, like saturated fats, raise bad cholesterol (LDL) and may lower good cholesterol (HDL). As if that weren't bad enough, they may also increase the risk of diabetes. Current labeling guidelines don't require manufacturers to state how many grams of trans fats are in a product, but the FDA has called for food labels to come clean. Look for trans-fat grams on all labels beginning Jan. 1, 2006.

VACCINES

The threat of bioterrorism jump-started dormant plans to create reliable vaccines against some of the world's deadliest agents. In October U.S.-government scientists began their first human trial of an experimental vaccine against Ebola, a lethal African virus that triggers severe internal bleeding and kills up to 90% of its victims. Experts have long feared that Ebola could be turned into a devastating bioweapon. Meanwhile, at Harvard, researchers created an anthrax vaccine that, unlike older vaccines, targets both the toxins created by the bacterium and the bug itself.

VISION

There's a new Lasik in town. You remember the old Lasik, the eye operation that improves vision by reshaping the cornea with lasers. The new version is called wavefront-guided Lasik and depends on technology developed by astronomers to correct problems in high-powered telescopes. Wavefront Lasik uses 200 little lenses to map the cornea, taking into account all its bumps and abnormalities to produce a highly accurate, individualized prescription. Conventional Lasik, by contrast, applies one standard formula to each eye. If the old Lasik is off the rack, wavefront is a custom-fit procedure. Studies show that the new method reduces the occurrence of common postsurgical side effects, such as halos, glare and bad night vision. But the risks of eye surgery still apply. Cost: up to $3,000 per eye.

VITAMINS

News continued to trickle in on the pros and cons of taking vitamins. Here's a look at the latest discoveries.

BETA-CAROTENE: Found in carrots and other colorful produce, this antioxidant and vitamin A precursor may help fight cancer--but not necessarily for everyone. A Dartmouth study showed that beta-carotene supplements were associated with a 44% reduction in the risk of precancerous colon tumors in subjects who neither drink nor smoke. But they appeared to double the risk of tumors in smokers who drink at least once a day.

VITAMIN B: Finnish researchers concluded that B12 (found in meat, milk and fortified cereal) may beat the blues. Depressed patients with the highest levels of vitamin B12 in their blood responded best to treatment.

Researchers in Boston found that high blood levels of vitamins B6 and B12, along with folate, are linked to a reduced risk of breast cancer in some women. And another study, at Georgetown, suggested that B12 and B6 may slow the progression of Alzheimer's disease by lowering blood levels of the amino acid homocysteine.

VITAMINS C AND E: Could strawberries and nuts prevent a stroke? Maybe. People who smoke have an increased risk of stroke, but diets high in vitamins C and E were found to cut the risk by 70% and 20%, respectively. In a separate study, the same vitamins, given to children with abnormally high cholesterol, led to improved blood-vessel function. A third study, of more than 6,700 people, showed that the higher the level of vitamin C in the blood, the less likely a person would be infected by Helicobacter pylori, a microbe that can cause peptic ulcers and stomach cancer.

VITAMIN D: A comprehensive study of more than 3,000 U.S. veterans found that fiber-rich diets that contain lots of vitamin D--the so-called sun vitamin, which is also plentiful in mackerel, salmon and fortified milk--significantly reduce the incidence of precancerous growths in the colon. British researchers linked an abundance of vitamin D to fewer fractures in people 65 years and older.

WINE

Score two more points for red wine. Researchers have long believed that the antioxidants in wine promote heart health. Now they have nosed out a couple more beneficial compounds. The waxy skins of grapes contain chemicals called saponins, also found in olive oil and soybeans, that researchers believe may lower cholesterol. Grapes, especially those grown in cooler climates, also contain resveratrol, which may play a role in longevity. The chemical has been shown in the lab to prolong the life of yeast by 70%, and it mimics the effects of a low-calorie diet, which can extend life span, at least in rodents, 30% to 50%. Scientists don't know whether resveratrol will turn out to be the fountain of youth for humans, but in the meantime, what better excuse to raise a glass or two of Bordeaux a day?

WRINKLES

Move over, Botox. Hyaluronan is the new rejuvenator. Found in the umbilical cord, some bacteria and the red combs of roosters, hyaluronan reduces inflammation in arthritic knees and prevents scar tissue after surgery. It's also what makes up the gel Restylane, a Medicis product recently approved by the FDA to plump wrinkles around the nose and mouth. (Botox is used to erase crow's-feet, furrowed brows and other frown lines.) Europeans and Canadians have been using Restylane for years. Another wrinkle buster, Hylaform, manufactured by Genzyme, is awaiting FDA approval.

ZOONOSIS

Infectious diseases routinely leap from animals to humans, often with devastating effects. AIDS and Ebola originated in apes, Creutzfeldt-Jakob in cattle, West Nile in birds and SARS in a little-known animal called the palm civet. Last year the exotic-pet trade took a 3-lb. Gambian rat from Africa to Wisconsin, where it infected a prairie dog with monkeypox--the first occurrence in North America. From the prairie dog, it jumped to a human and ultimately to 87 people in six Midwestern states. Increased globalization means these alien diseases are borne around the world with appalling speed. Makes you wonder, What next?