I do love a good “Year in Review.”
Over the years, I have never missed watching Barbara Walters special counting down the most fascinating people of the calendar year. I faithfully read Time magazines PERSON OF THE YEAR issue, and MacLean’s year in review. The last New York Times Sunday edition of the year is my special treat.
I mull over it for hours recapping events, attitudes and opinions of the year gone by as I sip a coffee or two and reflect on what has been.
I think the past has much to teach us. Historically we’ve been taught that we know who we are by learning where we have been- physically, mentally, and politically.
In medicine the same holds true. As a profession we advance on the shoulders of those before us. Future needs are often determined by past misgivings.
And so comes the time of year when we do just that- we look to the past 360 days and single out the best and the worst of this calendar year. We identify the most significant events to impact our cultural, political and scientific identities.
Why should Barbara Walters have all the fun?
Here it is, dear readers… my own reflection of the top six medical stories that indeed made us turn our heads in 2013. Indeed I could have had 10 more, but space would not permit and I must play favourites.
6. Angelina Jolie and the breast cancer gene
When Angelina Jolie announced to the world that she had tested positive for BRCA1 and BRCA2 and was having a prophylactic mastectomy, the world weighed in on the most private medical decision in a woman’s life. Forget the debate around sensationalism in the media, the story itself raised the issue about cancer screening in women. The scientific data on BRCA screening has shown that prophylactic mastectomies in high-risk BRCA1/2 positive women save lives. The decision is a personal one that a woman should make with her doctor and not her television set.
5. Soda and Sugar tax
From the proposed NYC soda ban to Mexico’s new Sugar tax the year was filled with stories about the dangers of refined sugar and sugar sweetened beverages. Emerging data over the last decade has shown that consumption of refined sugar and sugar-sweetened beverages dramatically increases the risk of development of obesity, hypertension and diabetes. Newer data shows that refined sugars alter neurochemical pathways in the brain linked to addiction and behavioural disorders. Have we heard the last on sugar? Certainly not, my sweet.
As a Canadian physician who reads many American medical journals, my reading material this year was filled with projections on how Obamacare would affect heath care practices. Did it affect Canadian healthcare practices themselves? Certainly not. I do think an open debate over “socialized medicine” only reinforces its necessity. As Canadians we are debating the benefits of a “two tiered system”. No system is perfect but I am biased. I grew up a prairie girl in a home where Tommy Douglas was king. As a physician who proudly practices socialized medicine I see its advantages and limitations every day. Obamacare and its debate only served to reinforce the importance of universal access to good care for everyone.
3. HIV vaccine
HIV vaccines successfully completed Phase 1 clinical trials in September of this year with phase 2 and 3 trials beginning. The possibility of a commercially available HIV vaccine has never been closer. As with any scientific breakthrough, the time from “bench to bedside” is variable. The time it will take to see these scientific developments translate into meaningful clinical outcomes remains to be seen. That being said, I never thought I would see an HIV vaccine in my lifetime. The next decade may bring just that.
2. Obesity recognized as a disease
As with any disease, obesity has a genetic predisposition, a set of physiological and biochemical mechanisms in the body and a set of environmental contributors. Our bodies are highly evolved in their methods to store and burn fat and when that system breaks down, obesity manifests itself.
But for decades we have “blamed the patient”. We have referred to obesity as a social condition and obese people as “failures” who lack the will to be well.
In August 2013, the American Medical Association recognized obesity as a disease. This was not real news. It was not something the medical and scientific communities did not already know. But it was, finally, an invitation for the world to accept people who struggle with this disease with empathy and kindness. Will this change decades of attitudes? I am hopeful but realistic. Instead, I believe that this mandate is now an opportunity for kindness in the treatment of a very challenging and multifaceted disease. This mandate now reinforced the idea that indeed this disease like many others requires evidence based therapies, ongoing management and above all, empathy.
1. Death with Dignity
On September 24, 2013 Dr. Don Low’s face was everywhere in Canada. A video of the highly respected physician filmed just eight days before his death hit the airwaves in the country and re-ignited the death with dignity debate. In October 2013, a BC court upheld the ban against assisted suicide. Quebec is currently debating this topic in its legislature. In 2010, Parliament voted against legalizing assisted suicide, but a bill currently before the Quebec legislature would, among other things, set the conditions necessary for someone to get help dying. The federal government has stated that it strictly opposes the concept and will leave it to the courts to decide. As for Canadians? Consistent polling has shown that 2/3 of Canadians support legalization of assisted suicide.
As a physician, I welcome an open discussion that allows patients with terminal diseases to legally engage in all options available to them surrounding end of life issues. As a nation we will be judged by how we treat our most vulnerable. Death with dignity and all end of life care issues are topics that are NOT going to resolve themselves. Canadians want to be involved in this discussion. I suspect this will be one of the biggest medical discussions in the year ahead.
Where are we headed medically in 2014, you ask? If this past year has anything to teach us (and usually it does) we will be faced with some challenging decision as patients, physicians and a populous. I think the themes will ultimately revolve around on how to deal with chronic diseases- their prevention and treatment and how to support an aging population with a system that is already challenged at best.
I hope that as Canadians we will continue to ask ourselves what is our own role in our health and the health of our nation.
I look forward to living and learning through it along with you.
I wish you all a happy and healthy New Year.