It’s not easy to say that any particular development in health or medicine was the most important in a given year. But if we had to choose some highlights, we would opt for these unforgettable events and findings.
As the number of opioid-related lawsuits against the pharmaceutical industry grew to nearly 3,000 nationwide this year, breakthroughs, however tentative, began to emerge. Oklahoma, the first state to go to trial, won a judgment against Johnson & Johnson for $465 million; the first federal trial, for two Ohio counties, settled just before opening arguments, for $20.4 million.
But there are indications that years of litigation lie ahead.
Purdue Pharma, which makes OxyContin, and the Sackler family who control the company, offered to settle all cases and sought bankruptcy protection to restructure. But two dozen states oppose the deal, saying the family itself should pay more. Three giant drug distributors and two manufacturers offered their own comprehensive settlement. But many states and thousands of local governments have flatly rejected it.
Coming soon in 2020: more bellwether trials around the country, including the first against the big pharmacy chains. And, of course, many more negotiations.
Nearly 12 years after the first person was cured of H.I.V., the virus that causes AIDS, researchers reported that they had cured a second patient. Their surprise success confirmed that a cure for H.I.V. is possible. Both milestones resulted from bone-marrow transplants given to the infected patients — to treat cancer, not H.I.V. While this is an unrealistic treatment option for millions of people living with H.I.V., rearming the body’s immune cells might work in the future.
Among men who are at high risk for H.I.V. infection, only about one in three is taking a drug to prevent transmission of the virus, the Centers for Disease Control and Prevention says. One of the main reasons has to do with cost. In May, the Trump administration reached a deal with the makers of Truvada and Descovy to donate pre-exposure prophylaxis, or PrEP, drugs to 200,000 patients annually for more than a decade. Experts said the donation was a good start, but it filled only one-fifth of the need in the United States.
Drug-resistant germs of all types thrive in hospital settings and nursing homes, Over the last five years, the fungus Candida auris has hit a neonatal unit in Venezuela, forced a prestigious British medical center to shut down its intensive care unit and infected nearly 800 people in the United States, with half of patients dying within 90 days. Once C. auris takes root, it is hard to eradicate from a facility. Some hospitals have had to bring in special cleaning equipment and even rip out floor and ceiling tiles to get rid of it.
The median medical education debt held by graduates in 2018 was $200,000. That does not include credit card debt, which can also pile up as students purchase stethoscopes and study-aid subscriptions, register for licensing exams and travel for testing. These costs can be especially prohibitive for some students, driving young doctors away from lower-paying specialties, such as pediatrics and psychiatry, as well as jobs in rural or less wealthy areas.
To address this problem, Cornell University and Kaiser Permanente have started to waive tuition for medical students, following in the footsteps of New York University last year. State repayment programs, such as CalHealthCares, also promise to help young doctors with debt relief.
In December, a federal appeals court struck down the individual mandate of the Affordable Care Act, which required Americans to buy health insurance or pay a penalty. But the court did not throw out the rest of the law, putting its fate in limbo even as access to health care has become a central issue in the presidential race.
Democratic candidates are divided over how to improve health care. Some want to eliminate private insurance and replace it with a single-payer system, or Medicare for All. Others favor a public option that would preserve private insurance, but give people a chance to choose government insurance.
Researchers have found that inhaling carbon dioxide at levels that are probably not uncommon in crowded spaces like small conference rooms might affect productivity and decision-making skills. This suggests that the recommended minimum air flow for such rooms might not actually be optimal. Instead, it might be worth cracking a door or a window, when possible.
As genetic testing becomes more widespread, parents, or sometimes their donor-conceived children, are discovering that the wrong sperm was provided by a sperm bank or fertility clinic. Facilities often use poor record keeping, writing sperm vial numbers in pen and ink rather than digitizing the sample data. And in a growing number of instances, doctors have secretly used their own sperm for artificial insemination, only to be discovered decades later.
One particularly egregious case, in which an Indianapolis doctor used his own sperm to impregnate at least 46 women, has prompted legal changes, including a Texas law that redefined such an act as sexual assault. But in many states, the laws applied to such cases remain unclear.
Some 200 million girls and women in Africa, the Middle East and Asia have been genitally cut. This traditional ritual, which ranges from nicks to extreme damage to the female anatomy, can cause pain during sex and child birth, and reduced sexual sensation. As some women move to the United States, demand is growing for surgery that can repair the damage.
One surgery, clitoral reconstruction, is viewed with caution by some medical experts. But some women who have had the procedure found that it helped relieve pain and made them feel more whole.
Researchers learned that tuberculosis had evolved a terrifying new strain in 2006 that is resistant to antibiotics typically used to fight the disease. Now, a clinical trial in South Africa is showing that a new regimen can cure most patients. The Food and Drug Administration has effectively endorsed the approach, giving scientists hope that other regulatory agencies will soon approve it worldwide.
In mice and human patients with pancreatic cancer, fungi seem to proliferate 3,000-fold compared with healthy tissue. Scientists have found that one fungus that can cause skin irritation and dandruff is also linked to inflammatory bowel diseases. Another study found that it was also present in extremely high numbers in pancreatic cancer patients. Administering an antifungal drug got rid of the fungi in mice and kept tumors from developing further.
The overwhelming majority of American parents vaccinate their children. But there are ominous trends in vaccine resistance, a byproduct of internet rumors, mistrust of Big Pharma, infatuation with anti-immunization celebrities and the anti-science rhetoric from the Trump administration. As a result, measles returned with a vengeance this year.
An outbreak centered in New York City forced Mayor Bill de Blasio to declare a public health emergency in April and order mandatory vaccination in parts of Brooklyn. Public health experts connected the outbreak to Jewish pilgrims who had not been vaccinated and went to Ukraine to visit the grave of a founder of a branch of Hasidism. From there, the measles virus spread to others who visited Israel, and eventually landed in Britain and the United States.
The International Life Sciences Institute, an American nonprofit, has been quietly infiltrating government health and nutrition bodies around the world. The organization rejects allegations that it works to advance the interests of the corporate members that provide its $17 million budget, but it championed tobacco interests during the 1980s and 1990s in Europe and the United States. And ILSI has recently expanded its activities in areas in Asia and Latin America.
In China, researchers have noted that the organization helped shape anti-obesity education campaigns stressing physical activity over dietary changes, a strategy long espoused by Coca-Cola. And in India, it helped appoint a former Nestle adviser to a government committee reviewing warning labels on unhealthy food.
This year, scientists developed an experimental therapy in record time to help treat 8-year-old Mila Makovec, who has Batten disease, a rare genetic disorder that involves rapid neurodegeneration and is fatal. It is believed to be the first custom treatment for a genetic disease because it blocks a mutation unique to Mila.
Scientists are also starting to test the power of psychedelic drugs to treat a range of mental health problems. In September, Johns Hopkins Medicine announced the opening of the Center for Psychedelic and Consciousness Research to study compounds like psilocybin and LSD. One study at the center has already found that psilocybin can be more effective at helping people quit smoking compared with using a nicotine patch.