What a long, strange year it's been

This has been a truly remarkable year for news and events, the likes of which we can only hope never to repeat. It has been remarkable not only for tragedy and the unity spawned in its aftermath, but also for the many advances in science and medicine, which were both stunning in their achievements and worrisome for the difficult moral questions they raised.

We saw advancements in genetic testing, high-tech reproduction, and artificial organs. We saw threats to human health from foot and mouth disease and bioterrorism. And we saw a great debate on the morality of human embryonic stem cell research before the attacks of September 11, and then revisited the ongoing debate on the morality of human cloning in the months that followed. As 2001 draws to a close and we enter what everyone hopes will be a better 2002, what can we expect from the year to come?

The fall and rise of biotechnology

By early 2001 the Internet bubble had burst, and along with it the market for biotechnology. But along with a sagging economy, President Bush inherited a growing controversy created by the promise of embryonic stem cell research. After months of public discussion and debate – including input from White House factions both for and against federal support for stem cell research -- the president announced the administration's decision to allow support for research on a limited supply of existing stem cell lines.

Late this year, the announcement of a supposedly successful attempt to clone human embryos showed the limits of the President's decision. It does not address research in the private sector on existing human embryos, making human embryos for research, or even cloning human embryos for research or reproductive purposes. Look for efforts in 2002 by Congress or the Food and Drug Administration (FDA) to regulate not only stem cell research in the private sector, but all reproductive technologies and reproductive medicine clinics, since they are the source for embryos and the expertise in making and manipulating them.

The resurgence of public health

Public health concerns came to the fore both early and late in 2001. Foot and mouth disease overtook hundreds of thousands of head of cattle in Europe, threatening to spread worldwide, and triggered strict quarantine of animals and public health measures for people traveling from contaminated areas. In the summer, helicopters again sprayed pesticide in New York City and elsewhere to combat the growing threat from West Nile virus-carrying mosquitoes. And then in the fall, threats to livestock and from insect-borne illness paled in comparison to fears of bioterrorism -- what may be the ultimate public health disaster.

The prospect of widespread attacks using anthrax or smallpox underscored the importance of public health readiness and how ill-prepared local and federal governments are for such disasters. When is quarantine acceptable and who has the power to enforce it? When are population-wide vaccination programs warranted, and can citizens be forced to be vaccinated? If there are limited supplies of vaccine or drugs to treat infection, how should they be allocated? The events of 2001 raised these and other issues.

Look for some tentative answers in 2002. State legislatures will consider instituting public health emergency powers laws, which will attempt to balance public protection and individual liberties. Mass vaccination campaigns may also be instituted to offer public protection against smallpox or other infectious agents, which will likely begin as voluntary programs and may remain so if sufficient numbers of citizens participate. The threats to public health we witnessed in 2001 remind us that while we should celebrate the marvels of modern medicine, we should never forget the value of the public health efforts that allow us to enjoy them.

2001 brought advances in science and medicine that make this a truly interesting time. We can only hope that 2002 will be just as memorable -- but for health, peace and prosperity rather than threats to them.