The shortage of prescription drugs, the challenge to the effectiveness of the flu vaccine, and concern over the dangers of radiation are just some of the top medical stories of 2011.
MPR medical analyst Dr. Jon Hallberg sat down with MPR's Tom Crann this week to review the year in medical news. Hallberg is a family medicine physician at the University of Minnesota and director of the Mill City Clinic.
An edited transcript of that discussion, followed by Hallberg's top ten list for 2011, is below.
Tom Crann: Let's jump right in here. These are in no particular order, but the one we're going to talk about first is drug shortages this year in the news, prescription drugs. What happened?
Dr. Jon Hallberg: It's all kinds of shortages. My colleagues in the hospital have been very frustrated by a number of things, including some antibiotics and especially chemotherapy drugs. We've noticed it also in the clinic setting a little bit. We'll get a call from a pharmacy that something we ordered is simply not available. And unfortunately we're starting to see more and more of this.
Crann: What happened to resolve it? Are we in a better situation now with, whether it's chemotherapy drugs or other drugs?
Hallberg: Well, I mean the FDA is sort of on top of this and have been sort of asked to figure this problem out, but one of the problems I think is that we're now to the point — because we have so many generics — if you've got one company or one factory that's producing one thing and they have a problem with the assembly line, well there goes your supply. And so that's just one of several issues that they're looking at right now.
Crann: Back in March, the tsunami in Japan, the earthquake, and then the nuclear meltdown at the Fukushima nuclear plant there... that put radiation in the news in a way it hadn't been in a generation.
Hallberg: Exactly ... I can't recall the last time I, you know, as a primary care person I actually started answering questions from patients about radiation exposure. And to continue that conversation a little bit, I think just in general we're sort of more aware of radiation in general. People are getting more cautious with how many CT scans we order and all of that, but I think that this really, really put that in the news.
Crann: Then we heard that while you still should get a flu shot, that flu shots are probably not as effective as originally thought.
Hallberg: Yes, that was a bit of a surprise. Dr. Osterholm's work that was published in Lancet found that the shots were more around 60 percent effective, rather than sort of the 80 percent that we'd thought, but like a lot of these things, I think it's good news in the sense it's going to prompt people to really think about, 'Let's make something that is 100 percent effective,' and not use technology that's decades old to create these vaccines.
Crann: Another topic that points to a certain uncertainty in the medical profession. We talk about this all the time, and that is confusion, if you will, over the PSA, the prostate screening, and also other cancer screenings, mammograms. They're in the news as well this year.
Hallberg: Yes. I think the silver lining with this, though, is that we're now getting mountains of data that we've been accumulating for years and years, and we're really sorting through things and we're sort of busting some myths. We all want to believe that there's something out there that can absolutely positively detect something with certainty that's going to make a difference, that's actually going to save lives, and that's what we found with the PSA screening is that it's just not saving lives the way we thought it was. And like the flu vaccine, we hope that there's a better one. We certainly hope that there's a better test for prostate cancer screening.
Crann: And then you sent me a link to a video. This is by a family doc by the name of Mike Evans, in Canada, and it's the question he gets from patients, 'What's the one thing I can do that will have a great effect on my health in different ways?' And what is that?
Hallberg: It's so simple. It's basically an exercise prescription. And his exercise is simply 30 minutes a day. It doesn't even need to be 30 minutes in a row. It can be three 10-minute segments, and he says walking is what you need to do. If we spend 23-and-a-half hours of the day sleeping, sitting, staring at either our television screens or work screens, that we owe it to ourselves for all kinds of reasons. And is it too good to be true? Perhaps, but the fact is that movement and exercise helps with everything.
Crann: And that's not just weight loss?
Hallberg: Oh my gosh, no ... They found even people who are heavy, even if they're obese, but they walk, they have less incidence of things like diabetes and arthritis and other problems because they're just moving. They're being active. So I think that that is sort of the simple, really simple message to leave with people at the end of the year is just move. 2012 needs to be a year of movement.
Dr. Hallberg's Top Ten List
1. Drug shortages: This has been a problem in hospitals more than in clinics, and the FDA has been tasked with fixing the problem, but it raises an interesting question: What happens when there's just one company that makes a drug and the plant is shut down (for one reason or another)?
2. Japan's nuclear meltdown: Not since Chernobyl has radiation been a water cooler topic of conversation.
3. Flu shots not as effective as we thought: Surprising to learn this, but it's a case of good science and research shining light on long-held beliefs. We need to know the truth — and develop a better vaccine.
4. PSA (and cancer screening) confusion: Another case of science telling us something we might not want to know. But the evidence is there: This test doesn't save lives. What we desperately need is a better test — and a way to differentiate between benign and aggressive prostate cancers.
6. Lipitor going generic: This was perhaps the biggest news regarding medications this year. Millions of patients are going to save hundreds of dollars a year on out-of-pocket expenses because of this. (Of course, millions have already switched over to cheaper "statins" to save money.)
7. Plan B denied over-the-counter status non-prescription availability for young women/girls: VERY controversial and a decision based on politics, not science. In many respects, acetaminophen (Tylenol) can potentially cause more harm to a person than Plan B.
8. PTSD and high suicide rate among returning soldiers: So sad. We've asked so much of our citizen-soldiers and put them in such difficult situations. Then we expect them to return home and re-integrate and resume their "normal" lives. For some, it's just too much. This problem, thankfully, is being addressed at a number of levels, and Minnesota is taking a national lead on this. But for many, it's too little, too late.
9. Contaminated spinach, cantaloupe, turkeys, and other foods: This year, like several in the recent past, has made clear our vulnerability with our food supply — and the need for even more safeguards.
10. Contagion in film: The Rise of the Planet of the Apes + Contagion: The closing sequence of the first film is a chilling reminder of how a novel microbe could travel this ever-shrinking world in ever less time ... with disastrous consequences. Contagion fleshes out the idea even more, though its portrayal of the Minnesota Department of Health is laughable, especially since we have one of the best (if not the best) one in the country. (Interview edited and transcribed by MPR reporter Madeleine Baran)