As we enter 2014, let's take a moment to reflect on last year's signature health news.
The Affordable Care Act slogged toward 2014
Bruised, bewildered and dodging political bullets, the Affordable Care Act (ACA), also known as "Obamacare," slogged through 2013. It stumbled badly at its October deadline to establish online marketplaces for purchasing health insurance. System errors plagued the HealthCare.gov website, frustrating consumers and obstructing enrollment. Millions of previously insured Americans felt betrayed when, contrary to the president's promise, their policies were canceled as ACA's implementation advanced. At the same time, hundreds of thousands of previously uninsured Americans cheered the ACA rollout as it newly granted them access to health care coverage in coming years.
Giving support to 'None-A-Day' vitamins
For the overwhelming majority of Americans, vitamins are useless -- so concluded three studies published in December's Annals of Internal Medicine. Among varied populations of people, regular vitamin intake offered no benefit in preventing cardiovascular disease, delaying mortality, enhancing memory or reducing cancer risk. Still, more than half of American adults regularly take a multivitamin, generously fortifying the $12 billion annual intake of the vitamin and supplement industry.
Additional food for thought
The year brought new warnings associating calcium supplements with greater cardiovascular mortality, energy drinks with harmful effects in adolescents and artificially sweetened beverages with Type 2 diabetes. In March, a judge overturned New York City's revolutionary ban on sugar-sweetened beverages, which had intended to curtail the obesity epidemic. And in November, the FDA announced plans to ban nearly all trans fat from America's food supply, a move aiming to prevent upwards of 7,000 deaths and 20,000 heart attacks each year. Broccoli remained untouched.
Obesity is labeled as a disease
At its annual meeting in June, the American Medical Association officially recognized obesity as a disease. Ostensibly, the declaration may facilitate better insurance coverage and physician reimbursement for expanded management of a condition affecting about one-third of Americans.
Nothing static about statins
In November, the American College of Cardiology and the American Heart Association issued revised guidelines for the use of "statins" -- prescription drugs traditionally used to lower "bad cholesterol" (LDL) toward specific target levels. The new guidelines abandoned that tradition, shocking most doctors and millions of patients who for two decades had been dutifully titrating statin doses according to results of regular blood testing for LDL levels. Instead, they advise that patients be categorized into four groups who should be considered for statin treatment: healthy people with a 7.5 percent, 10-year risk of heart attack or stroke; patients between ages 40 and 75 with diabetes; people between ages 20 and 75 with LDL levels beyond 190; and patients with known cardiovascular disorders.
Medical news that went viral
For such minuscule creatures, viruses generated enormous headlines in 2013. HPV (the human papillomavirus) took center stage in June when actor Michael Douglas announced that his oral cancer had been caused by an HPV infection he acquired from having oral sex. His disclosure raised considerable public awareness about the risk of HPV-associated cancers in men as well as women, and the potential for oral sex to spread sexually transmitted diseases (STDs). Last year also saw two new drugs -- simeprevir and sofosbuvir -- emerge from clinical trials looking a lot like hope for millions of Americans infected with the hepatitis C virus (HCV).
The DSM-5 was released
Finally, after years of contentious debate, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released. While many welcomed the modernized version of "the psychiatrist's bible," critics warned that its revised views about mental illness would newly pathologize millions of otherwise healthy people and exacerbate our country's excessive use of psychiatric medications.
Meanwhile, The New York Times reported in December that about 15 percent of high school students had been diagnosed with attention deficit hyperactivity disorder (ADHD), making it "the second most frequent long-term diagnosis made in children, narrowly trailing asthma." Furthermore, about 3.5 million children were being medicated for it. According to the report, a psychologist who had helped establish ADHD as a mental disorder saw the data as troubling evidence of overdiagnosis: —... a concoction to justify the giving out of medication at unprecedented and unjustifiable levels."
The Sunshine Act
An initiative aiming to curtail financial conflicts of interest between doctors and industry took effect in August. The "Sunshine Act" requires drug and device companies to report gifts or payments to physicians valued at or beyond $10 per transaction or $100 per year. By 2014, the total annual amount received by each physician will be brought to the light of day on the website of the Centers for Medicare & Medicaid Services.
In related news, Chinese officials alleged in July that drugmaker GlaxoSmithKline spent nearly $500 million at travel and entertainment agencies in attempting to bribe doctors and health authorities. The allegations arose just one year after GSK agreed to pay $3 billion in fines for bribing doctors and encouraging the use of inappropriate antidepressants for children — constituting the largest health care fraud settlement in U.S. history.
In May, actor Angelina Jolie announced she had undergone surgical removal of her breasts after blood tests for BRCA genetic mutations revealed a high risk for developing cancer in her future. Jolie hoped her story would empower people to become more fully informed about genetic testing and prophylactic options that might, possibly, save their lives. Cautious observers worried that a "Jolie effect" might influence healthy people to undergo unnecessary prophylactic surgeries and treatments for "possible" future problems predicated solely on statistical probability.
Hospital billing became a hip topic
For a long while, politicians and health care pundits have encouraged us to become savvier "consumers" to help contain health care costs. But last year, several studies revealed how tough it was to obtain pricing for various treatments or surgical procedures that would enable us to "comparison shop."
Other research exposed a widespread lack of transparency in hospitals' billing practices and an amazing variation in prices charged by hospitals for services and procedures. In March, a study in the Journal of the American Medical Association revealed a nearly 10-fold price variation for a standard hip replacement.
Kate Scannell is a Bay Area physician and the author of the novel "Flood Stage."