From the Salmonella saintpaul outbreak which sickened more than 1,400 people in the U.S. to autism and vaccines as well as bisphenol A in baby bottles, 2008 certainly generated its share of medical scare stories. We have likely not heard the end of these stories, but experts from different fields of medicine are now sharing their predictions about what we will be seeing more -- or less of -- in 2009.
By and large, the common thread tying together all the specialties in 2009 is the growth of personalized medicine -- a relatively new field in which doctors match therapies to prospective patients based on their genetic make-up. This way they can tell in advance which cancer, arthritis, or heart disease patients will respond to which therapies, eliminating trial and error. Pretty cool stuff.
But that's not all; 2009 will likely bring the first new drug for gout in over 40 years, a smart insulin pump with a mind of its own, and the beginning of an overhaul of the failing health care system.
Here's what the experts are saying about health predictions for 2009.
Health Care Reform: All Eyes on Obama
Health care reform will take center stage in 2009, says health care economist Karen Davis, PhD, president of The Commonwealth Fund, a private foundation in New York City. "For eight years, there has been a steady increase in the numbers of uninsured -- and the numbers of underinsured have jumped," she says.
"I definitely think President-elect Obama will seize this opportunity to mend our broken health care system. It is a top priority for him," she tells WebMD. "He will move health reform forward. The question is whether he will do it all at once or in pieces."
For starters, Davis predicts Obama will increase federal support for Medicaid, a government program that helps people with low incomes pay for medical care, and extend the time that people without jobs can hold on to COBRA (Consolidated Omnibus Budget Reconciliation Act of 1986). COBRA currently allows people to keep the health insurance they had through their former employer for up to 18 months.
"It's possible the reauthorization or renewal of the State Children's Health Insurance Program (SCHIP) could also be part of .... Obama's economic stimulus package," Davis predicts. "Stimulating the economy by investing in children's health is good for the productivity of work force."
Dieting: Goodbye Fad Diets, Hello 'Positive Eating' in 2009?
"The desire for fast, easy weight loss will always be a lure [but] with all the economy changes there is a growing trend to value -- and that value in the food arena is the aspect of how to get more from my food choices," says Connie Diekman, MEd, RD, LD, FADA, the director of university nutrition at Washington University in St. Louis and a past president of the American Dietetic Association.
"I do believe the nutrient-rich or positive diet message is growing," she says. Positive eating refers to adding vegetables, nuts, berries and other healthy foods to your diet as opposed to cutting carbs or taking other draconian measures to lose weight.
In 2009, consumers will also be choosing more locally-grown foods, she predicts. "Feeling in control of our world is leading people to choose more local foods."
"While we have a long way to go it seems more restaurants are looking at portions," Diekman says. Now public health advocates and dietitians can aim their bow and arrow at sodium. "Sodium is the next big nutrient focus. Consumers don't know how much they need, but they are interested in knowing how much is in what they eat."
There's more: expect to see more tasty foods for those with food allergies on store shelves in 2009. "More and more manufacturers are figuring out how to keep taste and drop the allergen," she says.
Diabetes: Will Smart Insulin Pumps Change Lives?
"There will be some big studies and new guidelines coming out in 2009 that may change how we treat diabetes," says John Buse, MD, PhD, chief of the endocrinology division and director of the Diabetes Care Center at the University of North Carolina at Chapel Hill. Buse is also the American Diabetes Association's president for medicine and science.
Buse also predicts that we may see some more glucose-lowering drugs come to market in 2009. Specifically, liraglutide, a new drug in the same class as Byetta (also known as exenatide) that only requires one injection each day, may be approved by the FDA as early as next summer. Once-weekly exenatide LAR is further down the pike.
These drugs would be alternatives to Byetta which requires two injections a day.
"These will be a nice addition," Buse says. Speaking of treatment, "we may see insulin pumps that can control themselves at night," he says. "It is a major leap for diabetes care to have a computer that controls insulin delivery."
Basically, a person with diabetes wears and controls the insulin pump all day, but at night the pump takes over, so if your blood sugar drifts down at night, the pump will reduce the amount of insulin that it puts out.
Arthritis and a New Gout Drug
According to Eric Matteson, MD, a professor of medicine at the Mayo Clinic in Rochester, Minn., 2009 will be a big year for our creaky joints and bones. "We will see more small-molecule drugs being researched and coming into trials," he predicts. Small-molecule drugs act like currently available biologic drugs, but can be taken by mouth, not injection or IV, which could be a huge boon to the millions of people with rheumatoid arthritis (RA).
What's more, 2009 will likely usher in the first new gout drug to come to market in 40 years. The drug, Uloric (febuxostat) recently got a nod from an FDA advisory panel. The FDA is not obligated to follow the advice of its advisory arms, but it usually does. As it stands, allopurinol (trade name, Zyloprim) is the only FDA-approved drug that prevents formation of the uric-acid-related crystals that cause gout, but side effects limit the amount of allopurinol that can be tolerated.
Personalized medicine will also play a role in arthritis, he predicts. "I would hope we will see the routine use of biomarkers for assessing disease severity and for treatment decisions."
Cancer: More Targeted Therapies
"There are some major cancer trials due to report in 2009 [including] whether or not prostate cancer screening saves lives," says Otis W. Brawley, MD, chief medical officer at the American Cancer Society in Atlanta. In this study, prostate cancer screening involves measuring blood levels of prostate-specific antigen (PSA), which is produced by the prostate gland. High PSA levels may indicate prostate cancer. This is coupled with a digital (finger) rectal examination.
There should also be a verdict on whether screening for lung cancer with spiral computed tomography (CT) scans saves lives in the coming year, he predicts. Both tests are considered controversial because they may have inaccurate results, and it is not clear if the benefits of screening outweigh the risks of any follow-up diagnostic tests and cancer treatments.
Screening aside, personalized medicine and targeted therapies will also be important for cancer care in 2009, he says. "We will continue to move toward targeted drugs and find some more targets for drugs such as Iressa," Brawley tells WebMD. Iressa blocks an enzyme called tyrosine kinase, which may help cancer grow and spread. This drug is only allowed to be used in patients who have previously taken it and are benefiting or have benefited from it. But, Brawley says, if doctors could find the Iressa receptor and only use this drug in patients who are positive for this receptor, it could be a great drug for those people. In a nutshell, this is personalized medicine. Iressa and other cancer drugs such as the breast cancer drug Herceptin that are known to benefit people with specific genes may be just the tip of the personalized medicine iceberg.
While 2009 may not be the year we win the war on cancer, "I anticipate that cancer mortality will continue going down in 2009," he says.
Heart Disease: New technologies and Old Prevention Strategies
"Diet and exercise are here to stay in terms of heart disease prevention," says Nieca Goldberg, MD, the medical director of New York University Women's Heart Program and author of several books including Dr. Nieca Goldberg's Complete Guide to Women's Health. She also thinks that 2009 will herald the emergence of computed tomography (CT) machines that use lower radiation doses when scanning arteries for blockages. "This may have an important safety advantage," she says.
The obesity epidemic will also continue to soar in 2009, she says. "We will see rising rates of diabetes as a result of obesity and greater efforts from national associations and communities targeting young people as kids are getting adult heart disease risk factors such as high cholesterol, high blood pressure and type 2 diabetes."