The Lancet, Volume 372, Issue 9656, Page 2087, 20 December 2008
Oh, what a year it was: a look back at medicine in 2008
A headline in last week's New York Times summed up the effect of the current economic crisis on the advertising business: “Next year is looking even worse.” But the freefalling global economy is not the only depressing event of the year. Even a shortlist of 2008 disasters, both natural and man-made, is mind-numbing: earthquakes in China, escalating conflict in Somalia and the Democratic Republic of the Congo, a hurricane that devastated the US Gulf Coast, floods in southeast Asia, a school collapse in Haiti, an ongoing cholera outbreak in Zimbabwe. Even in light of a grim prognosis for 2009, we know of no-one who is going around quoting the 19th-century English novelist Charles Kingsley—“Sad, sad to think that the year is all but done.” 2008 is turning out to be the kind of year one is heartily glad to see the back of.
But if the Wall Street Journal and the Financial Times, not to mention the 24-h white noise of television, radio, and the blogosphere, seem to be overflowing with unrelenting bad, worse, or utterly disastrous news, in the world of medicine it has been an intriguing, even hopeful, year. Take a break from checking your (dwindling? vanished?) bank-account balances. Here is a recap of better news, and the requisite portion of humble pie.
In this week's Lancet, we highlight some of the most important advances reported in 2008 in the medical literature, both in our journal and elsewhere. There was good news for patients with ischaemic stroke: they can effectively receive intravenous thrombolysis with alteplase for a longer window of time than had been previously thought. Stem-cell research took a leap forward in two studies. One, published in Cell, reported the induction of pluripotent disease-specific stem cells, which should pave the way for investigation into various diseases and the development of drugs to treat them. We published a report of the first organ transplant, a trachea, grown from a patient's own stem cells, thus negating the potential for rejection. (This stunning accomplishment might represent another historic first: it almost missed entering the annals of medicine thanks to a budget airline.) Patients with chronic obstructive pulmonary disease and those with advanced colorectal cancer and the KRAS mutation are the recipients of encouraging news about treatments. And the heartbreaking and seemingly intractable problem of neonatal mortality was improved in a simple community-based intervention in rural India, a development that should have ramifications far beyond its initial setting.
Other Lancet papers that we, our readers, and the press found especially noteworthy included the CONCORD study, which documented the wide global variation in rates of cancer survival. The ketogenic diet, long used in children with drug-resistant seizures, despite a lack of evidence from controlled trials, was confirmed as an intervention to reduce seizure frequency. Those who really hate working in the garden can now wave a cautionary tale in front of their more enthusiastic opposite numbers: gardening, we reported, can be a lethal activity. For the jetlagged who are reading this at some crazy hour, now you can go back to bed. A new melatonin agonist, tasimelteon, could come to your rescue.
Beyond our pages, authors reported in the New England Journal of Medicine that the outcomes of antidepressant trials are not always reported, thus skewing understanding of effectiveness and risk. Selective publication of drug trials? We are shocked. Finally, some winning advice from the Ig Nobel Prizes, by way of our Chicago colleagues. If you are going to buy a fake pain reliever, go for the expensive ones: they “work” “better”.
To no-one's surprise, we took some hits in the newspapers. Our series on child maltreatment brought forth the allegation, by no less an authority than the UK's Daily Mail, that we were undermining family life, through our publication of “small numbers, unrepresentative samples and generalised conclusions”. Brendan O'Neill, of spikedonline.com, went further, accusing us of publishing “flaky and shaky”…“unadulterated hocus-pocus”. These reactions were astonishing betrayals of child health—and hopes.
Finally, we admit to occasionally Googling ourselves. In a random sampling of 2008 headlines, we were called irresponsible and fanatical. Apparently, we launched scathing attacks, we savaged, slammed, blasted, and swiped at any number of targets. No wonder we are tired. So here is our forecast for 2009: we cheerfully intend to keep on doing all that and more—for the causes of patient care, global public health, and human rights around the world. Happy holidays.