Avandia, human genome among the things we've learned from in the past year

Mansfield News Journal

01/21/2008 - Every year the Harvard Health Letter chooses what it considers to be the top 10 health stories of the year. During 2007, there weren't many instant breakthroughs that would qualify as scientific discoveries. Instead, we saw a slow, steady accumulation of data from multiple studies and clinical trials that finally reached a critical mass that could be considered an important health story.

The first story is posed as a question about the drug Avandia. Did we learn anything from the unexpected side effects the drug produced? Avandia (rosiglitazone) will lower blood sugar and was marketed for use in the treatment of diabetes. The surprise came when it was found to increase the risk of heart attack and the overall risk of dying from heart disease.

The risk was small (one extra heart attack for every 1,000 people taking the drug), and the Food and Drug Administration allowed the drug to stay on the market. But the FDA added a "black box" warning about it. The FDA is supposed to allow only drugs that are safe and effective on the market, but no drug is entirely safe, and it would be impractical to require studies large enough to identify all of a drug's potential problems as a condition for approval.

What the FDA really needed was more money and more clout to make sure drugs are monitored for safety after they are on the market. The story here is that Congress passed legislation to give the agency the funding and the power. In addition, all clinical trials must now be recorded in a central registry.
Let's hope these changes will make a difference, and restore some of our lost confidence in the safety of our drugs.

The second and third stories concern gene research. The human genome (all of our genes collectively) consists of three billion chemical bases strung in a sequence, like letters forming the words in a very long book. The first diseases linked to genetic "misspelling" involved a single gene. When searching for misspellings that involve multiple genes, scientists would need to read the entire three-billion-letter genome.

Short-cuts have now been developed to identify "flags" that quickly lead investigators to the troubled genes. This also has helped to reduce the cost of such investigations. In 2003, it cost $10 million to $25 million to sequence all three billion base pairs. By the end of last year, the cost had dropped to $1 million, and some experts predict the cost will drop to $1,000 within the next 10 years.

In the future, children may have their genomes sequenced so doctors can tailor health advice and treatment to each person's genes. Obviously, this will present moral and ethical dilemmas to make sure the information is not used to discriminate or persecute, or invade privacy.

Story number four is about the growing body of evidence that indicates lack of adequate sleep plays a part in such maladies as diabetes, heart disease, high blood pressure, inflammation, and stroke. Somewhere between seven and nine hours of sleep becomes one of the key pillars of good health, right up there with diet and exercise.

Short sleep may also play a part in our obesity epidemic. Sleep, or the lack of it, alters the activity of leptin, the "fullness" hormone, and ghrelin, the "appetite" hormone. Adequate sleep is also necessary to store and make sense of the memories of the day's happenings. Sleep, as an activity, ought to be placed higher up on our list of priorities.

Your well being can be improved by incorporating some of these findings into your daily routine.

Dr. William Schamadan is a retired ob/gyn physician.