The Year In Medicine From A To Z

By David Bjerklie; Alice Park; Sora Song

AIDS

When the epidemic first emerged in the West more than 20 years ago, AIDS was circulating primarily among young gay men. Today, a record 39.4 million people, nearly half of them women, are infected with HIV, according to the latest report from the Joint United Nations Program on HIV/AIDS. The virus moved deeper into Asia and Eastern Europe, and new cases arose in every region of the globe, evidence of the need for more effective programs for treatment and prevention, such as halting the transmission from mother to child. Breast feeding accounts for as much as half of new infections among children in Africa, and studies in Thailand found that adding the antiretroviral drug nevirapine to AZT, which is given to HIV-positive women in their last month of pregnancy, cut transmission from 6% to 1%.

OraQuick, a new and faster HIV test that works with saliva as well as blood, may also help control the spread of AIDS. The sooner doctors can detect the infection, the quicker they can begin treatment--which is one of the best ways to keep a local outbreak in check.

ALCOHOL

For the 14 million Americans battling alcoholism, the holiday season--with its office parties and champagne toasts--presents a special challenge. Campral, the first new drug approved by the Food and Drug Administration (FDA) in almost a decade for helping drinkers remain abstinent, could help. Taken as part of an addiction-treatment program that includes psychosocial support, Campral helped 16% to 38% of alcoholics who had already stopped drinking avoid imbibing for up to four months. Unlike current abstinence aids, which either dampen the alcohol high or make people violently ill if they drink, Campral works by restoring nerve activity in the brain's pleasure center that is altered by overindulgence in alcohol. Campral's makers expect it to be available in time for New Year's celebrations.

ARTIFICIAL HEART

A dozen years after Barney Clark received the first experimental artificial heart, the FDA finally approved a similar device for broad use. The CardioWest, which is surgically implanted in the chest, fills in for the heart's pumping chambers, shunting blood throughout the body. But because it remains connected to a power console outside the chest, the device is only a temporary fix, intended to buy time for the sickest patients while they wait for a heart transplant. Still, it has proved effective. Patients put on CardioWest were more than twice as likely to survive for a year, increasing their chance of finding a suitable donor heart. Doctors are testing a fully implantable artificial heart called the AbioCor, but it has not yet been approved by the FDA.

ANTIDEPRESSANTS

Drugs prescribed to treat depression were much in the news this year, mostly because of their controversial use in children and adolescents. Although the drugs have helped thousands of depressed kids who might otherwise have thought about killing themselves, the latest studies show that the drugs actually increase suicidal thoughts and behavior in about 4% of children. Months after the British government decided to ban use of most antidepressants in children and teens, the U.S. finally took action. In October, the FDA directed manufacturers of all 32 antidepressants now on the market to add black-box warnings--its strongest caution--to doctors, alerting them to the risk.

ANTIOXIDANTS

Health-food stores and advocates of alternative medicine have long touted the benefits of antioxidants--compounds that can soak up free radicals in the body that promote aging, damage tissues and trigger cancerous growths. Blueberries, cranberries and raspberries are among the best-known sources for these health-promoting compounds, but the list got a lot longer this year when the U.S. Department of Agriculture (USDA) released its most comprehensive study yet of the antioxidant content of common foods. Among the new entrants: red beans, kidney beans, pecans, walnuts, ground cloves and cinnamon. Of course, the USDA can't guarantee that eating more of these foods will make you healthier, but its researchers are working on guidelines to help consumers decide how much antioxidant they need in their daily diet.

ALLERGIES

It didn't make sense at first, but more and more studies have come out to support the paradoxical notion that the best way to prevent allergies is to expose kids to the allergens that cause them. Scientists in Denmark found that the more pets a child has, the less likely he or she is to develop allergies later in life. Having siblings, living on a farm or spending time in a day-care center also reduces allergies. Why? Presumably because exposing still-developing immune systems to allergens primes the body to recognize them as harmless. The protective effect is negated, however, if parents expose a child to secondhand smoke.

BLUEBERRIES

Pterostilbene may sound more like a spelling-bee stumper than a lifesaver, but if early studies prove correct, this compound, found in abundance in blueberries, could be the foundation of a natural remedy to reduce cholesterol. In head-to-head lab studies against a cholesterol-lowering drug, pterostilbene was just as active as the pharmaceutical in dampening the cholesterol-producing functions of rat liver cells. And because pterostilbene targets a specific lipid-triggering receptor, scientists anticipate that it will have fewer side effects.

BIRD FLU

With 44 people infected and 32 dead from the avian flu, it wasn't a good year to spend time near ducks or chickens, particularly in Southeast Asia. Millions of fowl were culled in Thailand and Vietnam, which bore the brunt of this year's outbreak of H5N1 influenza, as fear of a widespread epidemic mounted. Public-health officials were particularly alarmed when the virus showed up in tigers, leopards and pigs, mammals that often serve as influenza bridges from animal reservoirs to humans. And in Thailand scientists identified one case of what they fear was human-to-human transmission: a mother fell ill and died from the flu after caring for her infected daughter. In the U.S., health officials are conducting trials on a bird-flu vaccine, hoping to head off a pandemic before it occurs.

BREAST CANCER

Genes play a leading role in determining who gets breast cancer, but environmental factors--such as the food you eat and the medications you take--were the big news this year. Researchers in Mexico reported that eating a high-carbohydrate diet, common in that country, seems to increase the risk, probably by raising levels of insulin in the body, which can in turn trigger cells to grow abnormally. In another study out of the University of Washington, doctors found that women who filled 25 or more prescriptions for antibiotics over a 17-year period developed breast cancer at twice the rate of those who didn't take the drugs. Researchers suspect that antibiotics may reduce the activity of gut microbes that normally protect against cancerous agents. Or the drugs may promote an inflammatory process that triggers tumor growth.

There was good news as well. A landmark study at Columbia University showed that women taking aspirin at least four times a week for three months cut their risk of developing breast cancer 30%. Doctors warn, however, that it's too early to recommend avoiding carbs and antibiotics or turning to aspirin to treat breast cancer. Though all three studies revealed potentially useful associations, none of them can show a direct connection.

CAFFEINE

Two separate reports showed a link between coffee consumption and a reduced risk of Type 2 diabetes. In a study that tracked coffee drinkers in the U.S. over a period of 18 years, doctors found that men who drank at least six cups a day were half as likely to develop diabetes, while women cut their risk 30%. In a separate study in Finland, which boasts the world's highest per capita coffee consumption, people who drank three to four cups of coffee a day had an almost 30% lower risk of diabetes, and serious caffeine users (more than 10 cups a day) cut their risk 60%. It's not clear whether the coffee was directly responsible for the lower diabetes rates, but further studies may confirm the connection, as caffeine is known to influence the way the body processes sugar.

CLONING

The brave new world of cloned babies has yet to materialize, but each year scientists get closer to copying humans. South Korean scientists announced in February that with improved techniques they managed to get cloned embryos to survive long enough for them to extract the world's first cloned human stem cells. In theory, such cells could be used to create any of the body's more than 200 tissue types. While that possibility is still years away, the new techniques could someday be used to obtain replacement tissue for patients using their own cells--thus avoiding the need for donors and the dangers of rejection.

CHOLESTEROL

With heart-disease rates in the U.S. showing no signs of slowing, health officials urged Americans to reduce their cholesterol levels well below those that have been considered normal. The change was prompted by five scientific studies that highlighted the benefits of cholesterol-lowering statin drugs. These studies identified a group of Americans at extremely high risk--among them, people who smoke, have diabetes, have high blood pressure or have suffered at least one heart attack--who could lower their heart-disease risk by cutting their level of LDL, the so-called bad cholesterol, from the previous target of below 100 mg/dL to below 70 mg/dL. Even people at moderate risk of a heart attack--those with two or more risk factors, such as high cholesterol, high blood pressure, being overweight or a family history of heart disease--should lower their LDL to below 100 mg/dL instead of the previously recommended 129 mg/dL or under.

CINNAMON

This aromatic spice may be good for more than stirring a hot toddy or sprinkling on a cappuccino. Cinnamon, it turns out, contains a molecule with insulin-like properties that may help people with Type 2 diabetes. A small study in Pakistan showed that 30 patients with diabetes had significantly lower blood levels of glucose, triglycerides and cholesterol after taking cinnamon for 40 days. In a separate study, however, scientists at the University of California at Santa Barbara and the Sansum Medical Research Institute found that not all cinnamon is created equal. While some varieties had no impact, others lowered blood-glucose levels in studies of obese mice.

CORONARY CALCIUM

One of the hardest things for heart doctors to do is predict, before the appearance of any symptoms, which of their patients are likely to have a heart attack. The Framingham Risk Score--which measures such variables as age, sex, smoking history, cholesterol level, blood pressure and diabetes--has helped doctors in the past, but it's not perfect. By combining the Framingham scores with advanced heart-imaging technology, scientists have found, physicians can significantly improve their ability to identify patients at risk. Known as the coronary-artery calcium score, the imaging data come from specialized CT scans of heart vessels that pick up calcium deposits around which plaques can form.

COUGH

Parents routinely administer a spoonful of cough syrup to a child who can't get to sleep because of a bad cough. The expectation is that the medicine will give the child--and the parents--a silent night. But does it work? When researchers gave a group of children with upper respiratory infections one of two active ingredients in over-the-counter cough syrup or a placebo, they found that the kids taking either of the cough-syrup ingredients had no better improvement in their symptoms than those taking the dummy liquid. In fact, all three groups had fewer symptoms on the second day. That should be a useful lesson for anxious parents: when it comes to coughing, sometimes the best medicine is to wait it out.

DIET

In a study published to great fanfare last March, the CDC announced that poor eating habits and inactivity were on track to become the No. 1 causes of preventable death in the U.S. by next year, surpassing even tobacco smoking. Well, someone at the agency miscalculated. The number of obesity-related deaths in 2000 was not 400,000, as the CDC reported, and may have been significantly lower. (Tobacco killed 435,000 people in 2000.) But even though the numbers may be off, the message stands: obesity is a major public-health threat in the U.S., and if it hasn't yet surpassed tobacco, it may do so one day.

DENTAL X RAYS

A startling report in the Journal of the American Medical Association suggested that expectant moms who get dental X rays may be at risk for having underweight babies. Researchers at the University of Washington in Seattle found that among the women they studied, those who had babies weighing less than 51/2 lbs. were twice as likely to have had dental X rays. Researchers were quick to say they didn't know how radiation might affect pregnancy or whether the babies' low birth weight was due to X-ray exposure alone. Whatever the risk, say the study's authors, it's small. They recommend that pregnant women not forgo necessary dental care.

ESTROGEN

A part of the big government-funded study known as the Women's Health Initiative was abruptly halted in 2002 after researchers found that women who took estrogen and progestin to replace the hormones lost during menopause raised their risk of heart disease, stroke and breast cancer. This year the National Institutes of Health shut down another arm of the study, one involving women who had had a hysterectomy and were taking estrogen therapy without progestin. It turns out that taking estrogen alone also raises a woman's risk of stroke and blood clots. There are benefits from taking estrogen--among them, better bone health and relief from hot flashes and other menopausal symptoms--but after two years, doctors say, the benefits no longer outweigh the risks.

EXERCISE

Few would argue that regular exercise and weight loss are not good for your health, but results from a large study of women with heart problems suggest that sometimes it's better to be fit than thin. Active women, no matter how thin or fat, were much less likely to have a heart attack and other cardiac problems than women who didn't exercise, according to the Women's Ischemia Syndrome Evaluation. But weight does matter. Researchers in the ongoing Women's Health Study found that overweight and obese women--regardless of how regularly they exercised--were as much as nine times as likely to develop diabetes as women of normal weight. Bottom line? Get active and stay trim.

FISH OIL

Sales of fish-oil supplements--one source of heart-healthy omega-3 fatty acids--are booming and poised to climb even higher. The FDA says sellers of food products that contain two types of fatty acids, EPA and DHA, which are found in oily fish like salmon, herring and lake trout, can now add labels listing their EPA and DHA contents and touting their health benefits. But there are limits to how much fish oil you should eat. The FDA recommends no more than 3 g of the fatty acids a day, and only 2 g should come from supplements. The problem is that the same contaminants that pollute fish-- PCBs, dioxin and mercury, among them--can show up in fish oils too. One study of British cod-liver- oil capsules found that they contained flame retardant.

FLU

The flu can be a serious medical issue for people with a delicate immune system, like the very young and the very old. Each year an average of 36,000 Americans die from the disease. This year, however, the flu became a political issue in the presidential campaign when, a few weeks before the election, one of the two companies that manufacture vaccine for the U.S. market was forced to withdraw 48 million doses, creating a massive shortage and triggering something of a flu-shot panic. Government officials scrambled to allocate fairly what was left, and the CDC says 58 million flu shots will be available to those who need them most. Advice for everyone else: wash your hands frequently; stay away from people who have the flu; and consider taking a prescription antiviral medicine like Tamiflu, Flumadine or Symmetrel, which can reduce your chances of getting sick.

FOLIC ACID

There's good and bad news on folic acid this year. First the good: a March of Dimes poll showed that women of childbearing age are heeding the advice on folic acid. Taking the supplement cuts rates of neural-tube defects like spina bifida as much as 70%, and the poll showed that 40% of women 18 to 45 are taking their daily dose--an all-time high. Perhaps as a result, rates of two major types of neural-tube defects have dropped 25% since 1995.

Now the bad news: although taking folic acid reduces blood levels of the amino acid homocysteine-- a major risk factor for heart disease and stroke--no matter how much you reduce your homocysteine with folic acid, your risk of dying from stroke or heart disease doesn't change.

HERBAL SUPPLEMENTS

Most consumers assume that dietary supplements marketed as "all natural" are safe. How far that is from being true was underscored this year by the Consumers Union, publisher of Consumer Reports, which issued a "dirty dozen" list of supplements that have been linked to cancer, kidney or liver damage and heart problems and some of which have been banned in Europe and Asia. What to avoid: aristolochic acid, comfrey, androstenedione, chaparral, germander, kava, bitter orange, organ or gland extracts, lobelia, pennyroyal oil, scullcap and yohimbe. In addition, the FDA says, consumers should steer clear of supplements called Actra-Rx and Yilishen, which contain prescription-strength levels of sildenafil, the active ingredient in Viagra. It can lower blood pressure to dangerous levels.

In a separate study, researchers at the University of Chicago found that ginseng, which is widely used to boost energy, can sometimes do more harm than good. In 20 volunteers, taking the herb disrupted the effects of the clot-busting drug warfarin, prescribed for millions of heart-attack patients. Because warfarin's dosage must be precise--too little can lead to clotting and too much can cause bleeding--any substance that alters its potency can have serious consequences.

LIPOSUCTION

Carrying too much weight--particularly around the belly--increases your risk of heart disease, high blood pressure and diabetes. Shedding the extra pounds will make you healthier--if you shed them the right way. Liposuction, a quick and increasingly popular way to lose weight, may not necessarily do the trick. Researchers writing in the New England Journal of Medicine described the plight of 15 obese women, each of whom had about 20 lbs. of abdominal fat surgically removed. Three months later, none of the women showed any improvement in insulin sensitivity, cholesterol level, blood pressure or other risk factors for heart disease.

LOW CARB

The low-carb potato has arrived. Developed by a Dutch seed company, the smooth yellow tuber has 30% fewer carbohydrates and 25% fewer calories than the average Russet Burbank. It's also moister and better tasting, says Chad Hutchinson, a potato expert and assistant professor of horticultural science at the University of Florida. Each year Hutchinson tests some 400 new varieties of spud for Florida farmers but finds, he says, "only a few we get really excited about." This creamy variety, named SunLite, "has risen to the top," says Hutchinson. SunFresh, a Florida growers cooperative, will market the lower-carb potato as a gourmet product and hopes to have it in stores by January.

NOISE

We're so used to noise, we hardly hear it anymore. Wailing car alarms, barking dogs, roaring leaf blowers, honking horns, grumbling washing machines, blaring TVs, squeaking baby toys--they all add up to the sound track of daily life. If it's not enough to drive you insane, says the National Institute of Occupational Safety and Health, it can still make you sick. Some 30 million Americans are exposed to daily noise levels that will eventually impair their hearing. Moreover, those who were destined to go deaf are doing so decades earlier than expected. Although it takes noises louder than 85 decibels (a typical hair dryer hits 90 db) to cause hearing loss, even softer sounds, like a ringing phone, can lead to hypertension, stress and depression.

At the Mayo Clinic in Rochester, Minn., nurses decided to see just how loud it got in recovery rooms where thoracic-surgery patients were trying to sleep. At the 7 a.m. shift change, the noise level shot up as high as 113 db--about as raucous as a jackhammer. The nurses finally hit on a simple solution that can help anyone get a little quiet time: they closed the door.

OBESITY

Americans in every age group are getting plumper and plumper. The number of overweight children ages 6 to 11 doubled between 1980 and 2000, and tripled among adolescents ages 12 to 17. Even the elderly are getting fat. The latest statistics show that 70% of Americans between the ages of 55 and 74 are overweight or obese, twice the percentage of 30 years ago.

The medical consequences of carrying around all this excess weight were made clear by a study published this month in the American Journal of Preventive Medicine. A survey of 73,000 adults conducted by researchers at the Fred Hutchinson Cancer Research Center in Seattle showed that being overweight significantly increases the risk of a long list of medical complaints, including coronary artery disease, congestive heart failure, hypertension, diabetes, depression, deep-vein thrombosis, osteoarthritis, fatigue, insomnia, indigestion, impotence and hip- and knee-replacement surgery.

So, what can we do about it? A good place to start is to cut back on sugary sodas and fruit drinks. A separate study reported that women who drank less than one sweetened beverage a month not only were thinner but also had a 40% smaller risk of developing diabetes than women who had at least one sugary drink every day.

PAIN

It's a big country when it comes to pain: 60 million Americans undergo surgery each year, 70 million complain of chronic pain, and half of all visits to doctors' offices are about pain. No wonder innovations in pain management make news. Among the latest: a single epidural injection that delivers 48 hours of time-released morphine; a portable balloon pump that delivers a continuous supply of a local anesthetic directly to the wound site; and a transdermal patch the size of a credit card that is as effective as a patient-controlled pump but doesn't require a needle and tubes.

Not all the year's news spelled relief, however. One study found that 44% of patients who take over-the-counter remedies for pain and inflammation take more than the recommended dose. Thirty million Americans pop these pills daily, and complications like stomach bleeding lead to more than 100,000 hospitalizations and 16,000 deaths each year.

PLACEBO

If taking a sugar pill can make you feel better, it must be all in your head, right? There's some truth to that, it turns out. Using an imaging technique that maps differences in blood flow in the brain, researchers were able to watch the placebo effect in action. Subjects were given harmless but painful electric shocks and then given a cream they were told would provide relief but actually contained no active ingredients. After the bogus salve was applied, scans showed that nerve activity in the brains of volunteers visibly changed. Regions involved in easing pain became more active, while areas involved in sensing pain quieted down. The expectation of relief seems to be self-fulfilling. Call it mind over gray matter.

PROSTATE

The link between PSA blood-test results and prostate cancer has become increasingly controversial. Faith in the PSA test was shaken when studies showed that many men whose test readings were in the normal range turned out to have prostate cancer. That faith was somewhat restored when further research suggested that the rate of increase in a man's PSA level, not the absolute level itself, determines the risk of death from the disease. Should there be new standards for interpreting PSA readings? Not necessarily. While tighter guidelines would almost certainly find more cancers, they would also prompt more unnecessary biopsies and cases of overtreatment.

REPRODUCTION

A pair of lab-mice studies roared in the world of reproductive biology. In the first, scientists created a mouse born by the fusion of two eggs. In the natural world this is known as parthenogenesis (from the Greek for "virgin birth"), a reproductive strategy used by some insects, invertebrates and the odd fish or reptile but unheard of in mammals. Given the technical difficulty, it's unlikely that you'll see this offered at the local IVF clinic anytime soon.

The second study may hold more immediate promise. Conventional wisdom has long held that when a baby girl is born, her ovaries hold all the eggs she will ever have, and that by age 50 or so, they are essentially gone. But that may not be the case, at least not in mice. Researchers discovered that specialized stem cells in the ovaries make new eggs throughout the mouse's life--and there is a hint the same might be true for humans. In theory, that could someday lead to new treatments for infertility and perhaps a new way to stave off menopause.

RU 486

When it was approved in 2000 as an alternative to surgical abortion, RU 486 was hailed by women's groups as the greatest breakthrough since the Pill. But after the deaths of three women who had taken the drug to terminate unwanted pregnancies, the FDA issued a black-box warning about the risk of death from bacterial infections and other complications. The pill's supporters insist that when properly used, RU 486 is no riskier than a surgical abortion and considerably safer than carrying a pregnancy to term.

SHOES

Sex and the City devotees may want to brush up on their algebra before they go shopping for their next pair of Manolo Blahniks. Mathematically inclined scientists at the Institute of Physics in London have devised a back-of-the-envelope (and slightly tongue-in-cheek) formula to help a woman determine just how high her heels can go before she topples over. Among the variables: number of years' experience wearing towering heels, time elapsed since the shoe was the height of fashion, and number of social cocktails the wearer plans to imbibe.

STEM CELLS

Despite scattered progress in funding embryonic stem-cell research at the state level (notably in California, which passed a $3 billion stem-cell bond measure), political pressure at the national level kept such research on the back burner. Meanwhile, there were several advances in the effort to get adult stem cells to work like embryonic stem cells (which can morph into any type of cell in the body). One small study involved heart patients undergoing bypass surgery. In half the patients, stem cells harvested from bone marrow in their hipbones were injected into their damaged heart tissue. The results were encouraging, but researchers don't know whether the stem cells transformed into new heart muscle, increased blood-vessel formation or somehow coaxed existing heart cells to become more active. Researchers are finding new sources of adult stem cells, including fat cells, skin, the brain and periodontal ligaments, the fibrous tendons that hold teeth in their sockets.

SMOKING

Why are some people hopelessly addicted to cigarettes, while others can seemingly quit at will? It may be, suggests recent research, that in those unlucky individuals who appear to be "born to smoke," nicotine triggers a pattern of brain activity that makes kicking the habit practically impossible. This strong neurobiological reaction to nicotine appears to be associated with hostile personalities marked by anger, aggression and anxiety.

If that's not scary enough, scientists pursuing another line of research believe they have found a physiological reason why nicotine and alcohol so often share each other's company. Even a small quantity of alcohol seems to significantly boost the pleasurable effects of nicotine. The numbers certainly won't comfort smoking barflies: 80% to 90% of alcoholics smoke, and alcoholism is 10 times as prevalent among smokers as among nonsmokers.

STATINS

Doctors have known for a decade that statin drugs can prevent or reduce the severity of cardiovascular disease by lowering blood levels of LDL. But how low is low enough? A landmark study of more than 4,000 heart patients compared a standard LDL-lowering regimen (40 mg of Pravachol) with an intensive regimen (80 mg of Lipitor) and found that even though both reduced LDL levels to below the recommended benchmark of 100 mg/dL, the patients on the higher dose were 16% less likely than those on the lower dose to get worse or die. The bottom line: what was once thought to be a laudable treatment target may not be good enough. Even by the current standard, less than one-third of the 36 million Americans who should be on statins are actually taking them.

STROKE

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.

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.

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

If you don't like contact lenses and you are one of the 3 million Americans whose corneas are the wrong thickness or shape for LASIK eye surgery, Advanced Medical Optics may have the lens for you. Called the Verisyse phakic intraocular lens, it is the first permanently implanted lens to correct nearsightedness that has been approved by the FDA. In trials over three years, 92% of myopic patients with 20/400 vision or worse improved to 20/40 vision; 44% of patients achieved 20/20 vision. One thing to keep your eye on: the implants take a toll on the endothelial cells that keep the cornea clear, and nobody yet knows whether this loss is harmful in the long term. For the time being, the FDA recommends the new lens only for eyes with a robust population of endothelial cells.

VITAMIN E

On the hit parade of supplements, few are as popular as vitamin E. For decades, millions of health-conscious Americans have taken their daily dose hoping that its antioxidant properties would help ward off heart disease, cancer and even Alzheimer's. Yet a review of 19 clinical trials involving more than 135,000 participants concluded that taking high doses of the vitamin (400 international units or more) may actually increase overall mortality and should be avoided.

The study was quickly rebutted by researchers defending E's virtues. While no one believes the vitamin will--or should--fall from dietary grace, don't expect the debate over megadoses of E to end anytime soon.

ZINC

Studies showing its benefits are still not conclusive, but that has not stopped zinc from becoming a popular cold remedy in the U.S. And enthusiasm for zinc is spreading overseas. Johns Hopkins scientists working with colleagues in Bangladesh found that adding zinc to traditional antibiotic treatment helped children ages 2 to 23 months recover more quickly (by a day or so) from severe pneumonia. In Iran, doctors added zinc to the widely prescribed methylphenidate (Ritalin) therapy for children with attention deficit/ hyperactivity disorder and found that after six weeks, the kids on zinc experienced fewer distractions and had less difficulty concentrating. In that instance, the zinc supplements may be regulating the brain chemical dopamine, which controls feelings of pleasure and reward.