YEAR IN REVIEW 2000: HEALTH-AND-DISEASE

Health and Disease In 1999 the international team of scientists participating in the $3 billion Human Genome Project made impressive strides toward the goal of locating, analyzing, and identifying virtually every one of the estimated 100,000 human genes. On December 1 it was announced that cooperating scientists from four institutions had meticulously mapped 97% of the genetic material contained on chromosome 22. As Francis Collins, chairperson of the publicly funded international project, noted, This is the first time that we've had a complete chapter in the human construction book. Mutation to genes located on chromosome 22 were known to play a role in several dozen human diseases, including disorders of the heart and immune system, certain cancers, mental retardation, and schizophrenia. Although chromosome 22 represents only about 1.1% of the genes in the human body, the scientists involved in the decoding effort expected to complete a first draft of the entire genome project early in 2000several years ahead of the originally projected completion date. A major bioethical debate during the year centred on research using human embryonic stem and germ cells, both first isolated in late 1998. While such research held great promise for scientific advances, it also raised serious ethical questions. (See Special Report: The Science and Ethics of Embryonic Stem Cell Research.) In October the Washington Post surveyed about 2,000 Americans to find out what issues were worrying them most. From a list of 51 possible worries, the single greatest concern, irrespective of political leanings, was that insurance companies are making decisions about medical care that doctors and patients should be making. Two other health care issues ranked among the respondents' top five worriesthat elderly Americans would not be able to afford the prescription drugs they need and that the respondents' current medical benefits would be reduced or eliminated. Americans had good reason to fear the power of insurance companies when in June the U.S. Justice Department's antitrust division approved the takeover of Prudential Health Care by Aetna, Inc., creating the nation's largest managed-care company. A spokesman for the group Consumers for Quality Care called the takeover a black eye for the Clinton Administration in terms of patient protection. Americans worried about health care may have gained some relief in November when the UnitedHealth Group, which insured 14.5 million people8.7 million in managed-care plansannounced that it would let doctors make their own decisions on care. The Minneapolis, Minn.-based insurer would no longer interfere with physicians' treatment choices, including the decision to hospitalize a patient. Physicians' groups hailed the step. Thomas Reardon, president of the American Medical Association, called it historic and a long overdue victory for American patients and the care they receive.