Looking back on 1997

BMJ 1998; 316 doi: (Published 17 January 1998) Cite this as: BMJ 1998;316:237
  1. George Dunea, attending physician
  1. Cook County Hospital, Chicago, USA

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    On the whole it has been a good year. The economy is growing slowly but steadily, so far unaffected by the Asian flu. The crime rate is down, even the use of cocaine is declining, and so is the prevalence of new cases of AIDS and deaths from it, in the United States though not elsewhere. Once declining cities are reviving, skid rows are being reclaimed and gentrified, but job security is “fragile,” and poverty remains an unsolved problem.

    We hear much about the dangers of television violence and internet pornography, and even more about global warming threatening to destroy trees and beaches and causing vast epidemics. Already it has been blamed for a malaria outbreak in Venezuela, and it may also greatly increase our grandchildren's air conditioning bills.

    Life expectancy, however, is now at 76.1 years; infant mortality is lowest ever at 7.2 per 1000 live births, and multiple births have quadrupled in 20 years thanks to fertility drugs, culminating in the recent births of septuplets in Iowa. The cost of treating such premature babies may exceed $1m (£625 000), plus follow up care and increased risks to the mother during pregnancy and delivery. But designer made babies may now be obtained for $2750 from a selection of embryos, custom made, or left over from in vitro fertilisation procedures. The eggs, once fertilised, are stored and later implanted into women, who can thus choose their offspring's pedigree on both maternal and paternal sides.

    In Oregon, last November, voters retained by a 20% majority a law allowing physician assisted suicide. Patients must be mentally competent, residents of the state, terminally ill, and must undergo counselling and a 15 day waiting period. Physician assisted suicide is prohibited in 34 states but the rest have no law.

    In Israel scientists have found that garlic's active ingredient, allicin, has bactericidal effects, apparently by reacting with enzymes’ thiol and sulfhydril groups. For the rare fish odour syndrome or hereditary trimethylaminuria, the gene was recently discovered but there is no therapy yet to enhance social acceptability. There is concern about the overuse of antibiotics and the emergence of antimicrobial resistance, largely because doctors tend to cave in to pressure from patients. Particularly worrisome is the overuse of vancomycin, leading to the emergence of vancomycin resistant enterococci and possibly staphylococci. The new antidiabetic drug troglitazone was found to have alarming effects on the liver; but thalidomide may be making a comeback and seems useful in some cancers, leprosy, Behcet's disease, and the severe aphthous ulcers of AIDS.

    Researchers have found that obese children are more likely to have coronary disease later in life; and that mental stress hastens the development of arteriosclerosis, as shown by finding thickened carotid arteries on ultrasound examination. The American Academy of Pediatrics now recommends breastfeeding babies for six to 12 months as a means of offering protection against infections and conferring various benefits on mother and child; and controversy continues on whether women should start having regular mammograms at 40 or 50. Finally, the Food and Drug Administration has approved a new drug for obesity, sibutramine (“Meridia”) that so far has caused neither pulmonary hypertension nor valvular lesions; and has mandated fortifying food with folic acid to prevent spina bifida, and possibly arteriosclerosis by reducing homocysteine levels. Reacting to a rising tide of food borne disease (9000 deaths yearly and much morbidity), it also decided that sterilising meat by irradiation is safe, does not change its taste or destroy its nutritional value, and does not make it radioactive or glow in the dark.

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