Health Predictions for 2009

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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 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 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, 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 pumps that can control themselves at night,”>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 , 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 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 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 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 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.”