Medical and Health News That Stuck With Us in 2016


As the year ends, the Science desk at The New York Times asked its reporters to look back at the news they reported on that was the most memorable. These are the selections, with a focus on health and medicine news.

Two other groups of reporters have also selected the news they find most memorable: Visit this link for a roundup of science. The year in climate change news will be published soon.


Zika: From Emergency to Endemic Threat

Image
A worker sprayed chemicals to kill the mosquito that transmits Zika in Bangkok in September, left; Aedes aegypti mosquitoes were bred for research at a laboratory in Recife, Brazil, right.
CreditLeft: Lillian Suwanrumpha/Agence France-Presse — Getty Images; Right: Mauricio Lima for The New York Times

The crisis began slowly at first. In fall 2015, neonatal intensive-care doctors in northeast Brazil began comparing notes and realized they had far more babies with microcephaly in their units than normal. They were severely deformed, with tiny heads containing brains that had stopped growing.

Questioning the mothers, the doctors realized that many had been infected while pregnant with Zika, a mild, mosquito-borne African virus that had never been seen in the Americas before 2015.

The crisis was not well-known outside the country until late December, when a health ministry official suggested that women in the affected areas avoid getting pregnant.

As the news made headlines around the world, desperate pregnant women began asking whether it was safe to travel to areas with Zika. On Jan. 15, the Centers for Disease Control and Prevention finally issued an alert advising them not to.

In the meantime, rumors had arisen that the Zika virus was not to blame for the deformed babies in Brazil. Genetically modified mosquitoes, pesticides, rubella vaccine and a larvicide used in drinking water were all blamed.

Image
Alba Sanchez and Jandy Vasquez at a clinic in Puerto Rico, left; At right, Milagro with her family in Colombia. Her mother was infected with Zika during her pregnancy and she was born with microcephaly.
CreditLeft: Ángel Franco/The New York Times; Right: Katie Orlinsky for The New York Times

On Feb. 1, the World Health Organization declared a public health emergency, specifying that it did so only to investigate the “possibility” that Zika caused microcephaly.

The next day, a case of Zika in Texas in someone who had not been overseas proved that what a few scientists had only suspected was true: The virus could be transmitted by sex. Public health experts were shocked — no other insect-borne virus had ever been transmitted by sex. Prevention messages had to change, because pregnant women had to be protected not just from mosquitoes, but from their own partners.

By then, more than 20 companies or institutes had begun working on a vaccine, but it was clear that none would be ready for years. Some said that the Rio Olympics should be canceled. Tourism to some countries plummeted.

As the months passed, the virus spread around the Western Hemisphere. In the United States, the virus hit Puerto Rico hard, but did not reach the mainland until late July, when four locally transmitted cases were detected in Florida.

Nonetheless, Brazil remained by far the hardest-hit country, with almost 2,200 confirmed microcephaly cases. Theories about the gap circulated, but no proof for any has yet emerged.

In November, the W.H.O. declared that Zika was no longer an emergency, but had become an endemic threat to babies. Many experts, fearing the virus would return next summer, criticized that decision as premature because it could still return next year. — Donald G. McNeil Jr.


The Body Fights Back

Image
Danny Cahill, center, won “The Biggest Loser” in 2009.
CreditIlana Panich-Linsman for The New York Times

When I met him last April he gave me his card, and I have not been able to bring myself to throw it away.

On one side there is a photo of a buff man, handsome as a model. “Danny Cahill,” it says. On the other side are two photos of Danny. On the left he is hugely obese. On the right he is slim, standing inside a pair of his old pants, so large it is almost inconceivable that he once wore them.

Yes, that is Danny Cahill, winner of “The Biggest Loser” reality TV show in 2008. He lost 239 pounds in seven months. He did it with a regimen that is hard to imagine — exercising seven to eight hours a day, aiming for a 3,500 a day caloric deficit. And when he won, he made his weight loss into a career.

If anyone was motivated to stay thin, it was Danny. But the pounds came back, despite his best efforts.

Scientists say that is what they would have predicted. But the contestants had no idea.

So I can’t forget Danny or the other “Biggest Losers” who starved themselves and exercised like maniacs to lose stunning amounts of weight, only to have their bodies fight back, with a slowing metabolism and a voracious hunger that forced them to regain weight.

I am haunted by baby-faced Sean Algier, who went to 289 pounds, from 444. He even ran a marathon, weighing 320 pounds, in his Biggest Loser effort. But the weight came back. Now, he learned, he is burning 450 fewer calories a day than would be expected.

His words stay with me: “It’s kind of like hearing you have a life sentence.” — Gina Kolata


Unleashing the Immune System on Cancer

Image
Jason Greenstein with his girlfriend, Beth Schwartz, at Presbyterian/St. Luke’s Medical Center in Denver in July.
CreditNick Cote for The New York Times

I watched the moment that a close friend died of cancer. His death — and life — took place on the precipice of extraordinary medical discovery.

His name was Jason Greenstein, and I will remember his story as much as any I have ever written, not just because he was a friend since childhood. Jason only died after surviving a cancer for more than a year longer than seemed realistic, thanks to the new marvel that is immunotherapy.

This emerging cancer treatment holds great promise in the efforts to fight the so-called Emperor of All Maladies. The goal of immunotherapy is to unleash the immune system to tackle cancer with the effectiveness it attacks bacteria or viruses.

But cancers often find insidious ways to stymie the immune system, like sending a signal that turns on a brake on the immune system.

In the last few years, a swirl of powerful scientific discovery has led to development of drugs that release that brake. Leading researchers are figuring out how to tinker on a molecular level with the complexities of the immune system.

I watched with no small awe as Jason initially experienced a seemingly miraculous recovery. One day, he was poised for hospice; weeks later, he seemed healed. He enjoyed a remarkable additional year of life. It was beautiful.

Alas, as his fateful end suggests, these therapies remain imperfect, don’t always work for a long period, and not for all cancers. And a second story I wrote chronicled some of the potent side effects of these therapies, including the rise of autoimmune disorders. — Matt Richtel


Birth Control, From the Obama Era to the Trump Era

Image
Sara Montoya, a student at California State University-Fullerton, uses an app to order contraception.
CreditJessica Pons for The New York Times

With the election of Donald J. Trump, advocates for reproductive health have been girding for changes that could affect women’s access to contraceptives. One of their questions: Will a Trump administration undercut the Affordable Care Act’s requirement that insurers cover birth control free of charge?

If such a reversal occurs, it would land at a time of strikingly innovative efforts to expand the availability of birth control that have so far proven popular and largely uncontroversial.

One set of developments I wrote about this year are birth control apps and websites that allow women to get prescription contraceptives without going to a doctor.

These ventures ask women to answer simple questions about their health and then either send birth control prescriptions written by clinicians to a woman’s pharmacy or ship the contraceptives directly to her door.

Some accept insurance, including Medicaid, while some charge modest fees.

More such ventures have cropped up since our article ran, and they dovetail with another effort taking place in several states, led by California and Oregon: laws that allow pharmacists to prescribe contraceptives in drugstores so that women can avoid visiting a doctor.

Women I have interviewed have been thrilled by the convenience of obtaining contraception without a doctor’s appointment, which for many would mean missing work or incurring co-payments.

But public health experts think the benefits will go beyond convenience, by encouraging more women to start, restart or continue using contraception and reducing the number of unplanned pregnancies and abortions.

If the Affordable Care Act’s contraceptive coverage requirement were reversed, it probably would not have too much of an effect on the apps, websites or pharmacist laws. But if some insurance policies stop covering birth control, some women won’t be able to afford it, whether they get it through an app or the traditional way. — Pam Belluck


Transplants That Made Medical History

Image
Lindsey McFarland, 26, of Texas, with her husband and doctors at a news conference after she underwent a uterus transplant at the Cleveland Clinic.
CreditDustin Franz for The New York Times

Two extraordinary transplants made medical history in 2016. One was a devastating failure. The other, though still a work in progress, has been a success.

On Feb. 24, Lindsey McFarland, a 26-year-old woman from Texas, became the first in the United States to receive a uterus transplant at the Cleveland Clinic. Born without a uterus, she hoped the transplant would enable her to become pregnant.

But on March 7—just hours after a celebratory press conference—Ms. McFarland began to hemorrhage, and the transplant had to be removed. The cause was later determined to be a yeast infection.

The uterus transplant program at Cleveland has been on hold ever since. Meanwhile, in September, doctors at Baylor University Medical Center performed four uterus transplants. Three failed, and the fourth went well, although it is too soon to know whether it will lead to a birth.

Image
Thomas Manning in his room at Massachusetts General Hospital in Boston after his penis transplant.
CreditKayana Szymczak for The New York Times

There was happier news from Boston in May, where Thomas Manning, 64, whose penis was removed because of cancer, had the first penis transplant in the United States at Massachusetts General Hospital.

The surgery was experimental, part of a research program with the ultimate goal of helping combat veterans, cancer patients and accident victims.

Within a few weeks of the transplant, Mr. Manning had normal urinary function. Sexual activity was expected to take longer to come back. Mr. Manning was in no rush, he said during a recent interview. He was busy getting ready to have another body part replaced: the aortic valve in his heart. — Denise Grady


A New Way to Save Teeth From Cavities

Image
Knox Urschel, 4, had a liquid treatment, silver diamine fluoride, brushed on a decaying tooth.
CreditCaitlin O’Hara for The New York Times

Tooth decay has a new foe. It’s an antimicrobial liquid called silver diamine fluoride, or S.D.F.

Drilling and filling a cavity is an uncomfortable affair, even when a dentist is gentle. Instead of getting that standard treatment, patients can now have S.D.F. brushed on cavities. No injection is necessary, a huge plus when a skittish toddler is in the dentist’s chair.

After the inexpensive liquid is applied with a tiny brush, the soft, decayed spot of the tooth hardens. Studies have shown a second brushing of S.D.F. six to 18 months after the first arrests cavities.

That’s a big deal — and a first.

Most people don’t realize that cavities are the result of an out-of-control infection that can only really be cured by improving their oral hygiene. Even after decay is removed and tooth structure restored with a filling, many people just end up facing the dentist’s drill, yet again.

What makes S.D.F. revolutionary is that it will actually kill cavity-causing bacteria. That said, there are downsides: Insurance may not cover it yet, and it makes teeth turn black.

The liquid seems particularly useful for children. Optimists are hopeful it could reduce the number of toddlers who end up getting fillings under general anesthesia, even though it may pose risks to their developing brains. That said, it is not the right treatment for all cavities. Big gaping holes still need fillings eventually.

For 18 months or so, S.D.F. has been available to American dentists under the brand name Advantage Arrest. Currently, they use it off label to treat cavities, as the Food and Drug Administration cleared the liquid for use only as a tooth desensitizer, so far. But researchers are pursuing F.D.A. approval for S.D.F. as a cavity treatment. — Catherine Saint Louis


Living Without Proper Plumbing, in America

Image
Dorothy Rudolph at her home in Tyler, Ala., which does not have a septic tank
CreditBryan Meltz for The New York Times

About 500,000 Americans live without the basic human dignity of proper plumbing, according to the Census Bureau. This year I visited Lowndes County in Alabama, where a substantial portion of that rural population, which is mainly black, struggles with this problem. Toilets in trailers are linked to white plastic pipes that snake just under (or on) the surface of lawns and empty into the woods beyond the line of mowed grass. Many of the county’s residents live in poverty, and still remember the Jim Crow South of their youth, and the turmoil of the 1960s.

The ground in Lowndes County does not absorb water very easily, and that makes it difficult — and expensive — to install septic systems. The systems can run around $6,000, far too much for many residents. I interviewed Dorothy Rudolph, a retired seamstress, whose husband, a carpenter, built their small clapboard home himself, some years after his family fled land owned by whites in the 1960s. They did not get running water until the 1990s, so when they put a toilet in their home and did away with the outhouse, it was a real sign of progress. Still, there was no money for a septic tank.

There still isn’t. Ms. Rudolph and her husband are on a fixed income. They keep chickens and a garden to help with expenses. The $6,000 price tag for a septic tank would be about half their annual income. So they suffer through the summer smells and the winter rains, which cause the toilet to back up, spilling sewage into the meticulously scrubbed bathroom. Sabrina Tavernise


Treating Pain, Limiting Addiction Risks

Image
Dr. S. Michael Keller, a physician at the Marion General Hospital in Indiana, with a patient. The hospital has struggled with prescribing opioids in its emergency room.
CreditJames Brosher for The New York Times

Pain is the chief reason that nearly 75 percent of patients rush to emergency rooms. And in E.R. culture, there is a longstanding conviction that the quickest, surefire way to douse that pain is opioids.

But with soaring rates of addiction to opioids and heroin, E.R. staff members and patients with pain have come to eye each other warily.

Doctors feel caught in a bind. They are under pressure to keep up their patient satisfaction scores. But often a satisfied patient is one whose pain has been treated, by any means necessary.

How to ease pain without putting a patient at risk for addiction? This year the staff at one of the country’s busiest emergency departments, St. Joseph’s Regional Medical Center in Paterson, N.J., has begun treating patients with alternatives to opioids, whenever feasible.

So rather than addressing lower back pain with Percocet, they are using trigger-point injections and lidocaine patches. For countless procedures they’re turning to short-acting treatments like nitrous oxide, known as laughing gas, guided nerve blocks or ketamine nasal sprays. You can even find therapy harpists wandering the halls, soothing the sick and miserable with gentle music.

During a six-month period that ended in October, St. Joe’s, as it is known, reduced its opioids by almost 50 percent among 1,600 E.R. patients with most common types of pain, like headaches, kidney stones or back pain.

Word of the protocol is spreading. St. Joe’s E.R. doctors have already spoken about their methods at nearly two dozen sites around the country. And at St. Joe’s itself, behavior among some patients is changing, too.

Instead of insisting that they be given opioids, more patients are coming to St. Joe’s particularly because they know that they or their children won’t reflexively be treated with those drugs, said Dr. Mark Rosenberg, chairman of emergency medicine. “We are different now, as a result of these tools.” — Jan Hoffman


Forward Motion on Mental Health Care

Image
Members of the Hearing Voices Network at the Western Mass Recovery Learning Community Center in Holyoke, Mass.
CreditJessica Hill for The New York Times

The field of mental health and behavioral science has been virtually static for decades. But when two developments in science and politics are seen together, they point toward future progress, if not yet a road map.

First, the micro: In January, brain scientists in Massachusetts reported a complete, rigorously tested biological explanation for schizophrenia. The group found that people who inherit a certain gene variant that is involved in neural pruning — a natural process, in which the connections between brain cells are consolidated — are at reliably heightened risk of developing the disorder. The findings provided the first good evidence for why the disorder most often shows itself in adolescence: This is the developmental stage when pruning is accelerated.

This research finally gives scientists a template for how to piece together the biological mechanisms that contribute to mental disorders. But as Eric Lander, president and founding director of the Broad Institute, which coordinated the research, said, “I won’t be ready to celebrate until I see patients benefiting from this work.”

That is what makes the year’s other big story so notable. For people who need effective, humane treatment now, there were hopeful signs of reform for the first time in decades. Internationally, institutions like the World Bank and the United Nations made funding mental health services a global priority. In the United States, Congress in December adopted language that would allow states to extend the reach of psychiatric services. And alternative, largely nonmedical options — like the Hearing Voices Network, a support group for people who hear voices — deepened their footprint, even attracting research money.

Both developments are somewhat incremental. But for a field that has been virtually stuck in place for half a century, 2016 provided the refreshing sensation of movement. — Benedict Carey

___

Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.



Source link

About admin

Check Also

What We Learned in 2017

It’s impossible to say that any particular scientific development was the most important in a ...

Leave a Reply

Your email address will not be published. Required fields are marked *