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YEARENDER: HEALTH

What we learnt in 2019 about health and medicine

New York

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.

Illnesses tied to vaping became an epidemic. Since mid-August, 2,506 lung injury cases and 54 deaths linked to vaping have been reported. Most patients were otherwise healthy and in their late teens and 20s. But after using a vaping device to inhale nicotine, THC or a combination of the two, many ended up in an emergency room, gasping for breath.

The likely culprit: an additive made with vitamin E oil. Several states and cities have imposed bans, mainly on flavoured e-cigarettes as a precaution.

The legal battle over opioids didn't get any easier. 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 US$465 million; the first federal trial, for two Ohio counties, settled just before opening arguments, for US$20.4 million. But there are indications that years of litigation lie ahead.

Coming soon in 2020: more bellwether trials around the country, including the first against the big pharmacy chains. And, of course, many more negotiations.

In 2019, it was found that it's possible to cure HIV in rare cases. Nearly 12 years after the first person was cured of HIV - the virus that causes Aids - researchers reported that they had cured a second patient. Their surprise success confirmed that a cure for HIV is possible. Both milestones resulted from bone-marrow transplants given to the infected patients - to treat cancer, not HIV. While this is an unrealistic treatment option for millions of people living with HIV, rearming the body's immune cells might work in the future.

But preventing H I V 's spread faces challenges. Among men who are at high risk of HIV 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 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 US.

Drug-resistant threat

Drug-resistant germs will be one of the nastiest new health threats we face. 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 centre to shut down its intensive care unit and infected nearly 800 people in the US, with half of its 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.

Today, mMedical school's costs still challenge many would-be doctors. The median medical education debt held by graduates in 2018 was US$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 specialities, such as paediatrics 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 programmes, such as CalHealthCares, also promise to help young doctors with debt relief.

In many parts of the world, sperm donation is a poorly regulated business. 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 digitising 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.

The re-invasion of measles made the headlines this year as an overwhelming majority of American parents asked to vaccinate their children. But there are ominous trends in vaccine resistance, a by-product of Internet rumours, mistrust of Big Pharma, infatuation with anti-immunisation celebrities and the anti-science rhetoric from the Trump administration. As a result, measles returned with a vengeance this year.

An outbreak centred 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 US.

Another trend is psychedelic and personalised medicine that offer innovations in treatment. This year, scientists developed an experimental therapy in record time to help treat an eight-year-old girl who had Batten disease, a rare genetic disorder.

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 such as psilocybin and LSD. One study at the centre has already found that psilocybin can be more effective at helping people quit smoking compared to using a nicotine patch. NYTIMES