From new blood pressure guidelines to the national epidemic of opioid overdoses, 2017 was another big year for public health news. Perhaps mirroring the tumultuous state of the nation and the world, much of the news was quite disconcerting, though you’ll find plenty of bright spots highlighted below. If there’s any silver lining to the negative developments, it’s that they’ve served to strengthen the resolve among researchers and officials to find solutions—or at least ways to mitigate—some of our worst problem areas (shout-out to the Lancet Countdown on health and climate change). Here, in rough chronological order, are 10 of the most important public health stories of this year.
Peanuts back on the menu for babies
In a turnaround from previous recommendations, the National Institute of Allergy and Infectious Diseases (NIAID) in January advised feeding peanut-containing foods to infants with severe eczema or an allergy to eggs (conditions that put them at high risk for peanut allergy) as early as 4 months of age. The updated recommendations were based on several studies that have found that introducing peanut-containing foods early in life reduces the risk of peanut allergy as children grow up. You can read NIAID’s full updated guidelines here.
Changing advice on PSA testing
The U.S. Preventive Services Task Force changed course yet again on its recommendations for PSA testing to screen for prostate cancer in men, releasing draft guidelines in April that leave the decision up to individual men, ages 55 to 69, depending on their “values and preferences” and in consultation with their doctors. (The previous guidelines, released in 2012, recommended against routine PSA screening. Note that screening refers to testing men without signs, symptoms, or history of the disease.) The Task Force cited newer research that strengthens the case that PSA screening saves lives, along with better ways to reduce the potential harms of the test (such as unnecessary treatment for nonaggressive cancers).
Cancer deaths continue to decline
Mortality rates from cancer are continuing their gradual decline in the U.S., dropping 1.5 percent annually over the past decade—slightly better than earlier improvements, according to a 2017 report, released in April, from the American Cancer Society (ACS). The decline has been driven by the most common cancers—lung, breast, prostate, and colorectal—and is due in large part to improvement in early detection and treatment and a steady decline in smoking, the ACS reported. Overall, the death rate from cancer has dropped 25 percent since 1991, which translates into more than 2 million fewer cancer deaths.
The opioid epidemic rages on
In the past four years, as many Americans died from overdoses of prescription opioid drugs, such as hydrocodone and oxycodone, as died during the entire Vietnam war. The reasons behind the epidemic are multiple and complex, but a big contributor has been the oversupply (that is, overprescription, particularly in certain areas of the country) of opioid pain relievers, which results in a nationwide reservoir of leftover drugs that then become accessible to family members or friends. The pharmaceutical industry has encouraged the epidemic through aggressive marketing and promotion to doctors, lobbying against government controls on their behavior, and selectively producing products conducive to addiction (and not producing analgesics that do not predispose to addiction).
Encouraging news about hormone replacement
Hormone replacement therapy for menopausal symptoms, notably hot flashes, may be safe for women after all when taken at menopause and not for a long duration, according to findings published in September from the long-running Women’s Health Initiative (WHI). The researchers analyzed 18 years’ worth of follow-up data on the participants in the trial—which was halted in 2002 amid findings that women taking the hormones had a slightly increased risk of stroke, heart attack, and breast cancer—and concluded that the use of hormone therapy was not associated with either increased or decreased mortality rates. That was true of the women who took estrogen plus progestin (the majority), as well as those taking estrogen alone (only women who had a hysterectomy). The new study focused on all-cause mortality as well as death rates from cardiovascular disease, all cancers, and other major illnesses. Other findings from WHI, published in August, affirmed the safety of vaginal estrogen, used to treat the genital and urinary symptoms of menopause.
Sugar in the spotlight (and it’s not a flattering one)
After decades of fat maligning, evidence is increasingly pointing to sugar—specifically the sugar that’s added to packaged and processed foods and beverages—as the prime culprit behind the skyrocketing rates of obesity and type 2 diabetes, not just in the U.S. but in the world at large. We convened a group of expert panelists in September at UC Berkeley to talk about the latest research and what consumers and policymakers can do to help curb our added-sugar consumption, before it’s too late. Here’s what these experts had to say.
Extreme climate events threaten health, well-being
Severe flooding following hurricanes in Texas, Florida, and Puerto Rico raised questions about how the influx of all this water could fuel the spread of infectious diseases such as Zika and dengue. Research in India, meanwhile, added to the evidence that rising temperatures due to climate change threaten not only our physical health but also our mental health, including raising the risk of suicide. A positive development: Recognizing the urgent need for further research in these areas, the Lancet this fall launched The Lancet Countdown on Health and Climate Change, an international collaboration of researchers and clinicians who will track the global progress on health and climate change from 2016 to 2030. Read the Countdown’s first annual report, released in October, and our exclusive Q&A interview with UC Berkeley’s John R. Balmes, MD, who is participating in the collaboration.
A new and better shingles vaccine
In October, the FDA and the CDC’s Advisory Committee on Immunization Practices approved Shingrix, a new shingles vaccine that is substantially more effective at preventing the disease—which causes a painful, blistering rash and can have nerve effects that linger for a year or longer—than the older vaccine, Zostavax. In clinical trials, Shingrix, which is given in two doses two to six months apart, was about 98 percent effective for the first year and about 93 percent effective over four years. (Zostavax, in contrast, prevents only about half of shingles cases, though it can lessen the severity and duration of cases that do occur.) Though final recommendations are pending, the CDC committee recommended Shingrix even for people who have already received the Zostavax shot. The committee also widened the age range for which the vaccine is recommended, advising that all adults get it starting at age 50, not 60.
New guidelines lower the threshold for high blood pressure
In November, long-awaited revised guidelines about high blood pressure from the American College of Cardiology and the American Heart Association lowered the cutoffs defining hypertension and thus greatly expanded the number of Americans who officially have the condition—from 72 million under the old guidelines to 103 million now. That’s nearly half of all adults, including many under age 45, along with nearly 80 percent of those over 65. Two key changes: The elimination of the prehypertension category, half of which now falls under hypertension, and an increased emphasis on lifestyle changes as the cornerstone of treatment.
Congress fights over repealing the ACA
As 2017 came to a close, the Affordable Care Act, aka Obamacare, remained the law of the land—but not for lack of efforts in the House and Senate this year to repeal the health care law and replace it with new legislation (anyone remember the American Health Care Act and Better Care Reconciliation Act?). We reported on the drama as it unfolded, covering, among other things, how the repeal of the ACA could affect people on Medicare, how the proposed replacement legislation might end up costing older adults more, and where to get free help choosing an Obamacare plan as long as they remain available.