The medical milestones that defined the noughties

Emma Wilkinson Health reporter, BBC News online

In 2000, Bill Clinton and Tony Blair jointly announced that a working draft of the human genome had been completed, paving the way for genetic tests and new treatments for cancer, diabetes, heart disease and even obesity.

So a decade on, has it lived up to its promise? And what are the other advances and milestones in medicine that have defined the past ten years?

Sir Mark Walport, director of the Wellcome Trust, says the work on the human genome project is beginning to realise some "fantastically important" results.

It has been a remarkable decade and the public has been fascinated by the developments Professor Roger Pedersen, University of Cambridge

"We saw just recently the publication of the cancer genomes.

"And we are getting a much better understanding of diseases, such as irritable bowel syndrome and diabetes, where we knew there was a strong genetic element but it's been very difficult to crack."

Unquestionably, he says, the legacy left by the race to sequence the human genome, which was eventually completed two years ahead of schedule, has been the development of very powerful DNA scanning technology.

"We can sequence new organisms that much faster which meant for example it was possible to identify SARS and swine flu very quickly," he adds.

Henry Scowcroft, science information manager at Cancer Research UK, says the recent publication of the cancer genomes puts researchers "in a much stronger position than ever before" to develop new diagnostic tests and treatments.

Stem cells

All of the scientists and doctors I asked pointed to the human genome map as the key development of the decade.

But it is far from the only groundbreaking achievement.

Another area of science with potentially far-reaching consequences for medicine is stem cells - that is cells that can be manipulated to form any type of tissue in the body.

The cloning of Dolly the Sheep followed by the isolation of human embryonic stem cells in the 1990s heralded the possibility that diseased body parts could be replaced with healthy new versions.

In 2007, scientists made a vital step forward when they reprogrammed adult skin cells to become stem cells overcoming the ethical issues associated with use of embryos and bringing their use in therapy closer to a reality.

MEDICINE IN THE NOUGHTIES June 2000, draft human genome published November 2002, first SARS outbreak in China September 2004, painkiller Vioxx withdrawn from market November 2005, first face transplant carried out in France March 2006, Northwick park drug trial puts six men in intensive care June 2006, Herceptin becomes available on NHS July 2007, smoking ban in public places finalised November 2007, human skin cells reprogrammed to become stem cells April 2009, first swine flu cases reported in what was to become the first influenza pandemic in 40 years

Professor Roger Pedersen, an expert in regenerative medicine at the University of Cambridge said key advances have been in the science but also in the public perception of the science.

"It has been a remarkable decade and the public has been fascinated by the developments," says Professor Pedersen.

"In the UK there was a 'let's get on with it' attitude - it was seen by the government as an opportunity - and the UK took at leading role in strategy and regulation."

He does point out that although the technology has moved at a remarkably fast pace, he and others were perhaps a bit naive about how quickly that would turn into real treatments for patients.

The noughties was also the decade that saw the first face transplant - previously the stuff of Hollywood fantasy.

And a pivotal moment in the treatment of thousands of patients was the introduction of Herceptin - a drug which targets the HER2 protein that fuels around a quarter of breast cancers.

"This is one of the first targeted therapies which made it through - it is proof you can do the basic research, find a target, go to clinical trials with a drug and get it through the regulations and that is a fantastic achievement," says Mr Scowcroft.

"If you look at what's in the pipeline now you see more and more of these types of drug."

Prevention

He adds that the watchword of the decade has been "prevention" with numerous interventions designed to stop diseases developing in the first place.

"The HPV jab is a really nice example of that - this is a vaccine introduced for a disease for which we already have a screening programme.

"There was a certain leap of faith in that.

"And the smoking ban was the most important piece of public health legislation for a generation."

Patients are far better informed than they ever were, it's been a tremendous shift, and if they're more informed they better understand their own bodies Professor Steve Field, Royal College of GPs

Professor Alan Maryon-Davis, president of the Faculty of Public Health, agrees the smoking ban was a "giant leap forward".

"But we have also had statins to cut cholesterol, emergency contraception available over the counter, chlamydia screening, steps to reduce salt content in food, and we have learnt a lot about planning for pandemics and heatwaves.

"The principle of prevention has been embedded in the public consciousness, we now need to make sure that the current economic climate doesn't put a strain on that."

Of course, the decade will also be remembered for the times when patients were let down and misled.

The commonly prescribed arthritis drug Vioxx was withdrawn after it was linked with heart attacks and strokes, a drug trial which went horribly wrong left six men fighting for their lives in intensive care, hospitals were names and shamed for MRSA and Clostridium difficile deaths, and measles made a come back after public confidence in the MMR vaccine plummeted.

Vaccine scares

Dr David Elliman from Great Ormond Street Hospital, said confidence in the MMR and vaccines in general is still "slightly fragile" and the internet means misinformation and rumour can spread quickly.

"We have seen deaths from measles in the not too distant past and a death from diphtheria in London so these diseases are still around."

Meningitis C, HPV and pandemic vaccines were introduced

Maybe one of the lessons to be learnt from the MMR story is the shift in how we access health information - the days of 'doctor know best' may be at least in some aspects, a thing of the past.

When the national pandemic flu line was launched, many accessed Tamiflu through the internet.

"Patients are far better informed than they ever were, it's been a tremendous shift, and if they're more informed they better understand their own bodies," says Professor Steve Field, chair of the Royal College of GPs.

"Over the next ten years, patients will need to be signposted to what's good information but also with more information available they will be able to better calculate their risk of diseases like cancer so they can take steps to prevent it and that's what the future will be about."

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