Triumphs, Troubles and Tea

It’s unlikely Woo Suk Hwang imagined his year would end this way. The veterinary scientist from Seoul National University made headlines around the world earlier this year–and was celebrated as a hero in South Korea–with a pair of triumphs in stem cells and cloning‚ including the world’s first cloned dog. But Hwang resigned from his post at a new stem-cell research center last week when it was revealed that he had lied about the source of some of the human eggs used in his medical research. The quality of Hwang’s science is unimpeached, but the reputation of the scientist has been pummeled.

This year, as every year, the struggle against disease was a grab bag of good and bad–vision and shortsightedness, courage and obtuseness, scientific masterstrokes and experiments that came to naught. It’s medicine’s historical dance, with every two steps forward matched by at least one step back. In a very good year, you might push that ratio to 3 to 1. TIME’s 2005 A-to-Z guide to the year in medicine tracks the highlights of the 12 months soon ending–and suggests that this year may have been one of the good ones.

By any measure, 2005’s biggest medical news came out of Hwang’s lab–despite the subsequent scandal. The earliest bulletin was the announcement that Hwang and his 45-person team had become the first to using cloning techniques to create stem cells from human patients suffering from diseases such as diabetes and spinal-cord injury. Tissue derived from those cells could, in theory, be implanted in the pancreas or spine with little chance that the body would rejected it. If such experiments work, the same approach could be applied to other parts of the body, such as the brain or heart.

More headline grabbing–and certainly more telegenic–was Hwang’s cloned dog, an Afghan hound named Snuppy (for Seoul National University puppy). Unlike sheep, cats and other animals that had previously been cloned, dogs are notoriously hard to duplicate. Their eggs can be extracted for only a few weeks each year, and canine anatomy makes removing them from the ovaries maddeningly hard. Hwang and his team had to be surgically deft to retrieve the eggs at all. But they also developed their own techniques for gently squeezing genetic material from a canine-donor egg and replacing it with the hound’s genes. Both steps reduce the damage to the resulting embryo and could have implications for human therapeutic cloning.

In recognition of that work, Hwang was named director of a new stem-cell center in Seoul with branch labs planned in the U.S. and Britain. He stepped down from that post last week after it was reported that a member of his team had purchased human eggs from as many as 27 women for use in the human stem-cell experiments and that two female members of his team had donated eggs to the cause. Egg selling became illegal in Korea not long after the secret sales, and it is considered a violation of scientific ethics for lab subordinates to provide ova, even free of charge. Hwang says he was not aware at first that team members had donated their eggs, but he learned of it later–and then publicly denied that it had happened. “I chose to protect my researchers’ privacy,” he says. As for the purchases from the other donors, he appears to have pursued a “Don’t ask, don’t tell” strategy. Hwang will continue to do stem-cell research at Seoul National University and remains a beloved figure in South Korea, where he now has no shortage of women willing to donate eggs free of charge for his research.

The uneasy marriage of money and medicine presented problems elsewhere in the world this year, particularly in the U.S. Around 46 million Americans still have no health insurance, and co-payments and deductibles are rising fast for those who do. Things were supposed to improve in November, when sign-ups began for the much touted and astonishingly expensive–an estimated $725 billion over 10 years–Medicare prescription-drug benefit for senior citizens. But so far, seniors don’t seem pleased.

Some drugs are covered, some aren’t, and beneficiaries don’t know how to easily find out whether theirs qualify. Seniors are forced to choose among dozens of possible plans–a whopping 47 prescription-drug plans in Maryland alone. And even if someone enrolls, the program has a hole in the middle: benefits are capped at $2,250 in 2006, unless drug costs reach $5,100, at which point payments kick in again. For people with no drug coverage, the new benefits could make life a lot easier. But those who have some coverage will have a hard time deciding whether to stay with what they know or jump to the government’s complicated offering.

Things got even worse in 2005 when health policy descended to health politics, and never more so than during the tragic burlesque surrounding the death of Terri Schiavo, the 41-year-old brain-damaged Florida woman whose husband petitioned to have her feeding tube removed. Advocates on both sides of the end-of-life debate leaped into the fray, but it was in Congress that the situation came truly unhinged. Senate majority leader and heart surgeon Bill Frist “spent an hour or so” viewing a widely circulated videotape of Schiavo–but never examined the patient–and pronounced himself unconvinced that she was irreversibly brain damaged. Tom DeLay went further, opining that Schiavo “talks and she laughs and she expresses happiness and discomfort.” An autopsy later showed that Schiavo never could have recovered. Her ruined brain had atrophied to half its normal size.

Politics and medicine intertwined again in the battle over the so-called morning-after pill, or Plan B, which is designed to prevent pregnancy from occurring if taken within 24 to 72 hours of unprotected sex. Religious conservatives object to the drug, seeing it as abortion by chemistry and likely to encourage sexual activity among kids. The pill was made available by prescription in 1999, and in 2003 the manufacturer sought Food and Drug Administration (FDA) approval to make it available over the counter. Three FDA panels and an outside advisory committee recommended that the agency okay the change–usually all that is required. But the FDA gave it a thumbs-down.

Pro-choice groups charged that ideology was driving health policy, and a newly released report by the Government Accountability Office suggests that the fix may indeed have been in. Then FDA chief Mark McClellan and other FDA officials reportedly informed subordinates in 2004 that the Plan B application would be rejected, no matter what.

The FDA found itself in an even more difficult spot concerning the question of when to place safety warnings on prescription drugs–an issue that draws heat no matter what the agency decides. The twin revelations that the hyperactivity drug Strattera could increase suicidal thoughts and the painkiller Vioxx could double the risk of heart attack and stroke led to charges that the agency had failed to protect the public. The FDA responded by announcing that it would change the standards it uses for placing warnings on drug packaging, adding new or beefed-up labels when there is merely evidence–not proof–that a medication may be dangerous. To date, the agency has issued more than a dozen health advisories this year pertaining to drug risks compared with just two in 2003. For its pains, the FDA is now being charged with crying wolf.

If medical issues got muddled in the U.S., where health care is at least generally available, the situation improved in the developing world, where too often it is not. In 2003 a polio epidemic broke out–eventually reaching 17 African and Asian nations–when Muslim leaders in northern Nigeria banned the polio vaccine, claiming that it could spread AIDS or sterilize girls. After a year’s hiatus, the government lifted the ban, and this year the World Health Organization and Rotary International, with a grant from the Bill & Melinda Gates Foundation, began an aggressive revaccination campaign, chasing polio out of 11 of the countries in which it had newly taken hold.

The Gates Foundation also took the lead in battling malaria, which kills 1 million people each year. The foundation increased its already generous grants for research by $258 million, which means that it will soon provide more than a third of the world’s entire malaria-research budget. Elsewhere, an experimental vaccine created by pharmaceutical giant GlaxoSmith Kline has been shown to reduce severe malarial episodes almost 50% in some types of cases and to remain effective for at least 18 months. That’s far from lifetime immunity, but it’s closing in on the goal.

Against such crises, U.S. health worries can seem frivolous–particularly our preoccupation with our waistlines. But the American obesity epidemic remains serious. An estimated 65% of us are overweight or obese, including 16% of children ages 6 to 19.

However, things are changing. McDonald’s, which has been publicly lashed for its role in creating the supersize culture in the first place, took supersizing off its menus in 2004 and recently announced that it would begin putting nutritional information on the packaging of all its products by 2006. Former President Bill Clinton, a survivor of quadruple-bypass surgery, and Arkansas Governor Mike Huckabee, who famously lost 110 lbs. after his Type 2 diabetes was diagnosed, have formed a bipartisan tag team, working with the American Heart Association to get the message of healthy eating and exercise out to kids.

There was plenty more that made news in health this year–the highlights of which are described in the pages that follow. At the end of 2005, the world may not be an appreciably healthier place than it was at the end of 2004, but with new drugs rolling out, new techniques being tried and new initiatives being launched, our tools are better than ever. Now we must learn how to put them to good use.