80 Aint Old Makes Number Two in Top Ten Health
Stories of 2008 by Harvard Health Letter
Others of high importance to senior citizens
advances with adult stem cells, generic drugs now the norm, how low for
blood sugar in seniors
Dec. 4, 2008 - The top 10 health stories of 2008
may not be as funny as David Letterman's nightly countdown, but they can
actually make a difference for long-term health. And, there is no age
group that appreciates advances in health maintenance more than senior
citizens for the obvious reasons.
Here are this year's winners, chosen by the
editorial board of the Harvard Health Letter:
Note: This story about the Hypertension in the Very
Elderly Trial (HYVET) was added in December to the SeniorJournal.com archives after it became a stop health story for 2008
First human trial is for patients at end of
therapeutic road
Jan. 23, 2008 Two patients facing possible leg amputation have become the
first to be treated by transplanting a purified form of the subjects own adult
stem cells into the leg muscles with severely blocked arteries in hopes new
small blood vessels will grow and restore circulation in the legs.
The single-minded pursuit of low blood sugar levels
is probably not the best approach to type 2 diabetes, particularly in
people ages 60 and older. People with diabetes should not give up blood
sugar control, but three clinical trials show it's unwise to be
overzealous about lowering high blood sugar, and certainly not without
also attending to high blood pressure and cholesterol.
2. 80 ain't old.
Results from the Hypertension in the Very Elderly
Trial (HYVET) showed that reining in high blood pressure pays off even
in an age group that was once viewed as being extremely old-those 80 and
older. After two years, the treated group in the study had lower rates
of heart failure, strokes, and deaths overall. HYVET is more evidence
that the age for effective medical intervention-through pills, surgery,
or devices-is getting older and older.
3. Nice name, nice numbers, but let's see what
you can do.
Results from two clinical trials reported this year
dinged the reputation of cholesterol drug Vytorin (ezetimibe plus
simvastatin).
One showed that in people with a rare inherited
condition, Vytorin did a great job lowering cholesterol but didn't
reduce atherosclerosis. In a second trial, among people with aortic
valve stenosis, Vytorin again lowered cholesterol, but it didn't slow
progression of the valve disease or reduce serious cardiovascular
events.
Vytorin seems to be another example of a new
medication that ought to be prescribed sparingly until we have better
evidence that it really improves health.
4. What "adult" stem cells might do for you.
Last year, several research groups discovered ways
to genetically tinker with adult cells so they look and behave like stem
cells from embryos. These reprogrammed cells are called induced
pluripotent stem (iPS) cells.
This year, researchers showed how iPS cells might
be used. Skin cells from two older patients with Lou Gehrig's disease
were transformed into iPS cells and then coaxed into becoming neurons
and other cells that might be used to treat the disease.
Insulin-producing pancreatic cells were made from
iPS cells that came from human skin. And two research teams reported
that they had found new ways to make iPS cells, another step toward the
day stem cell therapy will leave the lab and enter the clinic.
5. Gene tests: Progress and Pandora's Box.
Personalized medicine based on an individual's
genes inched closer to routine use this year. Doctors have started to
order gene tests to assess how sensitive people are to the blood thinner
warfarin (Coumadin), although there are some doubts about how useful
such tests will be.
Meanwhile, many direct-to-the-consumer genetic
tests hit the market. The tests have raised some concerns. Will they be
done correctly? And even if they are, the predictive powers of this
early generation of gene tests might be oversold, so some people could
be unduly scared while others are falsely assured.
6. Seeing right through you.
A new generation of imaging machines, called
multidetector CT scanners, is making pictures of the inside of the body
faster and with incredible detail. Speedy CT scanners are proving to be
especially valuable in hospital emergency departments, where time is of
the essence.
But are we going to pay a price for all of these
pictures? The cancer-inducing radiation from CT scans is much higher
than that of the traditional x-ray. Radiologists are taking steps to
reduce the amount of radiation per scan and to eliminate unnecessary
scans.
7. War wounds that don't show.
Psychiatrists at the Walter Reed Army Institute of
Research reported the results of a study this year that counted the
number of mild traumatic brain injuries-concussions-among returning
troops. Almost half of the soldiers whose concussions had caused a loss
of consciousness met the criteria for post-traumatic stress disorder
(PTSD), and about a quarter of them were suffering from major
depression.
8. Generic Rx: Shopping for health care in the
global village.
Once the exception, generic drugs are now the norm.
This year, about two-thirds of the prescriptions written by doctors were
for generic drugs.
Generic drugs have taken off for many reasons.
Brand-name blockbusters (Fosamax, Zocor, and Zoloft) have lost their
patent protection in recent years.
The Medicare Part D prescription plans have loaded
up their formularies with generics.
But a crucial and underappreciated factor has been
the role of low-cost suppliers, many of them in India. Given the
potential problems with contaminated imports, the FDA has promised to
step up its overseas inspections.
9. Awareness test doesn't make the grade.
Being awake during surgery after being given
general anesthesia is one of those bad dreams that sometimes comes true.
The bispectral index (BIS) is a formula that uses
the values of measurements of the brain's electrical activity to come up
with a single number that is supposed to measure "anesthetic depth."
More than half of the operating rooms in the United States have BIS
technology. But it's been controversial, partly because the company that
sells it has kept the formula secret.
This year, researchers reported the results of a
study that tested the BIS monitoring in a 2,000-person randomized trial.
BIS-guided anesthesia was no better at identifying anesthesia awareness
than another kind of monitoring. This is another case when the results
of an independent clinical trial have called into question the value of
a widely adopted medical practice.
10. Health care reform: If not soon, when?
Some argue that the Obama administration will be
hard pressed to take on something so organizationally and politically
complicated as health care reform during such a sharp economic downturn.
The counterpoint: health care reform is essential
for any kind of durable economic recovery. So far, the signs are that
health care reform will stay near top of the new administration's
agenda. Regardless, the effects of the downturn were beginning to show
in late 2008 and are likely to increase in 2009.
The health care building boom of the last few years
will almost certainly slow down, and the number of Americans without
health insurance may increase if the economy continues to shed jobs.
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Keep up with the latest news for senior citizens, baby
boomers
Dec. 4, 2008 - The top 10 health stories of 2008
may not be as funny as David Letterman's nightly countdown, but they can
actually make a difference for long-term health. And, there is no age
group that appreciates advances in health maintenance more than senior
citizens for the obvious reasons. 