Health in 2005: What May Come (cont.)

Von Frohlich also says celebrity-endorsed fitness programs are passe as most noncelebrity fitness seekers do not have the same time, money, or motivation that celebrities do and are instead opting for fitness that fits into their lifestyles.

Catching Zzz's

The recent approval of a new, longer-lasting sleeping pill, Lunesta, "will open up the possibilities of chronic treatment of insomnia," says Timothy Roehrs, PhD, director of research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit. "This drug is effective up to six months and will change the prescribing habits as doctors will feel more comfortable prescribing it for longer," he says. By contrast, current market leader, Ambien, is only prescribed for seven to 10 days. With Ambien, many insomniacs get to sleep, but they wake up in the middle of the night. However, a controlled-release form expected in 2005 may help better maintain sleep.

Indiplon is also nearing the market in two formulations, fast acting and "modified release." WebMD recently reported that two other sleeping pills are also in the pipeline and nearing final stages of studies. They include TAK-375 from Takeda, a Japanese firm, and gaboxadol from the Danish firm H. Lundbeck in partnership with Merck.

Advent of Arthritis Alternatives

The withdrawal of the Cox-2 drug Vioxx by Merck & Co in 2004 and recent disclosures that other nonsteroidal anti-inflammatory drugs may also raise risk of heart attack and stroke will continue to evolve and change the way aches and pains of some forms of arthritis are treated, says John H. Klippel, MD, president and CEO of the Arthritis Foundation. The brouhaha "has created an interesting dialogue about risks and benefits, and every time a consumer chooses to take a drug, they have to understand the risks and accept them." Moreover, newer Cox-2 drugs are waiting in the wings, he says. "The fact that we have now had a discussion about the existing Cox-2 drugs in 2004 will make it difficult for any of the newer generation drugs to be approved in 2005."

He also predicts an expanding role for anti-inflammatory medications called biologic drugs, such as tumor necrosis factor (TNF) inhibitors, which block TNF, a protein that plays a key role in inflammation and joint damage.

But that's not all the new year will bring for the millions of people with arthritis. "I think it's likely we'll see new approvals for Rituxan and an introduction of abatacept in 2005 for [rheumatoid arthritis]," he says. Abatacept is part of a new class of medications known as co-stimulation modulators that block the cells of the immune system that cause inflammation and release inflammatory chemicals. Rituxan is a cancer treatment for use in lymphoma and works by targeting and depleting the B-cells also known to play a role in inflammation.

Flu Fears Flourish

"We are really worried about the bird flu but can't make any predictions [about it]," says Dave Daigle, a spokesman for the CDC in Atlanta. "I think the avian [bird] flu has the potential to be a big story in 2005." As it stands, officials at the World Health Organization warn that millions of people may die if the bird flu virus spreads among humans. Spread would take very close contact with infected birds or another infected human. So far, there have been only 44 known cases, resulting in a chilling 32 deaths in Thailand and Vietnam. It also led to the slaughter of millions of poultry across the region.

In light of the highly-publicized shortfall of flu vaccine this year, Daigle says he is also worried about a flu epidemic. "The peak takes place after January, and we have seen a late peak in past years, and we are hoping that people who didn't get a shot will go out and get one now," he says, noting that some states and cities may have an excess.

For Skin Care, Less Is More

"For 2005, I expect to see more noninvasive procedures for skin rejuvenation that have less downtime and less recovery," New York City dermatologist Ariel Ostad, MD, an assistant clinical professor at the New York University School of Medicine, tells WebMD. "A good example includes Thermage skin tightening for eyelids, jowls, neck, arms, and abdomen as opposed to liposuction with more downtime and recovery." Thermage is a noninvasive technique that uses radiofrequency waves to tighten tissues while cooling the skin to minimize redness. Moreover, "I also anticipate lasers with much less downtime than are currently in use."

Diabetes Decisions Anticipated.

John B. Buse, MD, PhD, chief of the division of general medicine & clinical epidemiology and the director of the Diabetes Care Center at the University of North Carolina School of Medicine in Durham, N.C., expects to see two new drugs approved for diabetes in 2005. "Exenatide will be approved for type 2 diabetes, and I expect that Symlin may be approved for type I and type 2." Symlin is a man-made version of human amylin, a hormone secreted with insulin, while exenatide is a first-in-class drug that works by improving glucose control among people with type 2 diabetes who are not using insulin and are not achieving target levels with diet and oral medications.

"The only thing holding these drugs back is that they have to be injected, and there is a bias in the mind of patients and providers that injections are difficult, but I am looking forward to them becoming available."

Published Dec. 22, 2004.

SOURCES: Louis J Aronne, MD, clinical professor of medicine, Weill Cornell Medical College, New York; president, The North American Association for the Study of Obesity. Mark L. Jewell, MD, president-elect, American Society for Aesthetic Plastic Surgery. Robert Morgan, MD, division of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, Calif. Ann Kulze, MD, author, Dr. Ann's 10-Step Diet: A Simple Plan for Permanent Weight Loss and Lifelong Vitality. Eric von Frohlich, group exercise instructor at Equinox, New York; chief exercise officer, Timothy Roehrs, PhD, director of research, Sleep Disorders and Research Center, Henry Ford Hospital, Detroit. Dave Daigle, spokesman, CDC, Atlanta. John H. Klippel, MD, president and CEO, Arthritis Foundation, Atlanta. Ariel Ostad, MD, assistant clinical professor, New York University School of Medicine. John B. Buse, MD, PhD, chief of the division of general medicine & clinical epidemiology; director, Diabetes Care Center, University of North Carolina School of Medicine, Durham, N.C.

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