From the development of a new source of stem cells and the availability of the over-the-counter weight loss drug Alli to the emergence of a strain of drug-resistant Staphylococcus aureus bacteria, 2007 heralded some major medical advances along with its share of setbacks. We have likely not heard the end of these stories, but experts from different fields of medicine are sharing their predictions about what we will be seeing more -- or less of -- in 2008. By and large, 2008 will be a year where medicine takes baby steps toward eradicating diseases like cancer and makes a dent in burgeoning epidemics such as diabetes and obesity.
Cancer: More Targeted Therapies
Will 2008 be the year we cure cancer? "Absolutely not," says Otis Brawley, MD, the chief medical officer at the American Cancer Society in Atlanta. But that's not to say that it won't be a banner year in the war against cancer.
For example, 2008 may usher in some more targeted cancer therapies. These therapies interfere with specific molecules involved in the process by which normal cells become cancerous. "We will see more drugs like this come out that prolong life by months, but not by years," he says. "I wish I could say there will be this great study with this great drug, but we are just not there yet."
But it's not all gloom and doom. "We cure a substantial number of people who have cancer today," Brawley says. "We really need to start publishing the numbers of people whose lives have been saved. One-third of people with cancer survive long term and are technically cured and that's a far higher proportion than 25 years ago. We need to develop a little more optimism about cancer."
Other questions that should be answered definitively in 2008 are whether or not prostate cancer screening and screening for lung cancer with spiral computed tomography (CT) scans save lives, 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.
Recently some research has shown that these drugs, which stimulate red blood cell production, may actually promote tumor growth and/or cause blood clots. "We are going to learn more about how to use these drugs," Brawley says. "They do have a place in oncology, but they have been overused."
Diabetes: Is the Epidemic Finally Over?
The diabetes epidemic may plateau in 2008, predicts John Buse, MD, PhD, chief of the division of endocrinology at the University of North Carolina in Chapel Hill and the president of medicine and science at the American Diabetes Association.
"We are starting to see early hints that the extremely rapid increase in the numbers of people with diabetes may have turned the corner," he says. "I do think that things are improving relatively rapidly."
As for "diabesity," the converging epidemic of obesity and diabetes, "people are individually and personally trying to make efforts, at least in segments of the population, so there is reason to hope things will be better in 2008 than in 2007."
There probably won't be any new diabetes drugs in 2008, Buse says, and fewer patients will be using a class of drugs known as glitazones. In 2007, one such drug, Avandia, was linked to an increased risk for heart attack in people with diabetes.
Inhaled insulin hit a snafu in 2007 when Pfizer announced that it would stop selling Exubera for financial reasons. But "inhaled insulin is not dead as a concept," Buse says. "Perhaps a smaller device that is easier for patients to use and is associated with reasonable expectations will have a place in the future."
Plastic Surgery: Less Is More
Less will be more in 2008, predicts Foad Nahai, MD, the president of the American Society for Aesthetic Plastic Surgery and a plastic surgeon in private practice in Atlanta.
"I think what we are going to see more of in 2008 is a continuing interest in injectables, fillers, toxins, and other noninvasive procedures [to reduce some of the visible signs of aging]," he predicts. "What we are going to see less of are the very complicated and sophisticated face-lift procedures that provide probably the best results, but also require the longest recovery."
Overall, "men and women will be opting for less in terms of the result and going with injectables because there is no downtime and no recovery time," he says.
"The other thing that we will see is growth in products to use at home," he says. "Eventually there may be an effective cream or treatment that would match the injectables and fillers."
Still, plastic surgeons won't be going out of business anytime soon. "There are still lots of things that the knife can do that needles and creams can't," he says. For example, plastic surgeons will use 2008 as time to work on refining the proper sequencing for body-contouring following weight loss surgery. When people experience such dramatic weight loss, they are often left with loose, hanging skin and opt to undergo multiple body-contouring surgeries such as tummy tucks, arm lifts, and/or breast lifts to tighten and tone. Plastic surgeons are now trying to determine the best order to perform such surgeries.
And one more thing, he adds. Just because pop star Britney Spears reportedly underwent lipodissolve, don't expect this fat-dissolving technology to become all the rage in 2008.
"We just don't have large studies looking at how effective it is and how safe it is," Nahai says. "We should wait until we have studies that prove its safety and then it will rapidly become very popular." There may be some short-term results on lipodissolve published in 2008.
Rheumatology: New Drug Alert
Leslie J. Crofford, MD, the Gloria W. Singletary Professor of Rheumatology and the chief of rheumatology at the University of Kentucky in Lexington, has her eye on the prize in 2008. "I hope we will see another new biologic approved to treat rheumatoid arthritis (RA) in 2008," she tells WebMD. Specifically, she is referring to tocilizumab (Actemra). This drug blocks an inflammatory chemical known as interleukin-6 (Il-6), and is in final stages of clinical trials.
Crofford says she is "really excited" about this drug for people who may not respond to similar drugs. Biologic drugs block substances that cause or worsen joint inflammation in RA. They copy the effects of chemicals made by the immune system, which block inflammatory substances such as tumor necrosis factor (TNF).
"Preliminary studies look extremely promising and it seems to have a particularly good effect in pediatric patients. And we may ultimately, when approved, see studies of this agent in other rheumatic diseases."
Speaking of other rheumatic diseases, Crofford says, "I hope that we will see clinical trials looking at biologics in lupus and I hope that we will see approvals for more medications to treat fibromyalgia that target the central nervous system." In 2007, the first ever such drug to treat the chronic pain condition fibromyalgia was approved, and according to Crofford, Lyrica (pregabalin) won't be the last.
Neurology: Mixed Outlook for 2008
2008 will be a mixed bag for stroke and other neurological conditions, says Deepak L. Bhatt, MD, the associate director of the cardiovascular coordinating center and an interventional cardiologist at the Cleveland Clinic in Ohio.
"There are two warring factors," he explains. "We have better treatments and less invasive therapies on the horizon, but this has the potential to be overwhelmed by the twin epidemics of diabetes and obesity," he warns. While some researchers suggest that the diabetes epidemic may be reaching a plateau, there are still millions of Americans who have the condition and may not have it under control.
"There is trouble brewing," he says. "Even though there have been some encouraging downward trends in stroke rates, those gains could easily be reversed by epidemic of diabetes."
Cardiologists and neurologists will be working together more often in 2008 as strokes and heart disease share many of the same risk factors including high blood pressure, diabetes, and smoking, Bhatt predicts.
There has been some back and forth on the potential use of cholesterol-lowering drugs called statins in preventing future strokes among people who have had strokes due to a blockage in the brain arteries. Research has shown that such stroke survivors who took statins had a lower risk of fatal and nonfatal strokes of any kind as well as heart attacks and heart disease. That said, stroke survivors who take statins may also have an increased risk of experiencing a bleeding or hemorrhagic stroke.
"We are going to see a lot more enthusiasm among neurologists about the use of statins in patients who have had an ischemic stroke," he predicts. "The data overall in these patients show that use of a statin does reduce risk of future heart attack, stroke, and death."
Cardiology: Will HRT Make a Comeback?
Nieca Goldberg, MD, a New York City-based cardiologist and the medical director of the New York University Women's Heart Program and author of several books including the forthcoming Dr. Nieca Goldberg's Complete Guide to Women's Health, fears that 2008 may bring about some disheartening news.
Hormone replacement therapy (HRT) may make the news again in 2008, she says. The use of hormones fell from grace in the summer of 2002 when the U.S. government halted the hormone arm of the Women's Health Initiative early because of an increased risk of heart attack.
"We are going to get some more fine-tuned information about hormone therapy because of the increased numbers of women going into menopause and who have symptoms," she says. Such as? "For women who don't have heart disease risk factors or have heart disease, maybe HRT is not as harmful to the heart as we once thought," she says. Stay tuned.