Now that we've wrapped up another year, it's time to look back at the top health and medical stories of 2003. From SARS to HRT to the flu, the physicians at the Harvard Medical School recall what made health and medical news this past year.

1. SARS

A novel coronavirus leapt from animals to man in Southern China in late 2002 and became a household word this year. The viral pneumonia infected more than 8,000 people worldwide. It was moderately contagious, and was a particular threat to health workers. The disease was fatal in 10 percent to 40 percent of people. A worldwide research effort identified the virus, produced diagnostic tests for it, and started work on a vaccine, in a matter of weeks -- an unprecedented accomplishment made possible by new scientific techniques and the Internet. Extraordinary public-health efforts snuffed out the epidemic, at least this time. Recurrent epidemics are possible, but next time the world will be better prepared.

2. Atkins Diet Gains Credibility

Dr. Robert Atkins died in April, one month prior to the publication of two articles that showed that his diet can produce effective short-term weight loss. For three decades, Dr. Atkins had advocated for high-fat, low-carbohydrate diets as opposed to more traditional low-fat diets to treat obesity. The long-term consequences of remaining on a very high-fat diet are unknown. Perhaps the most positive effect of the Atkins diet is that people are putting more emphasis on reducing total calories and eating healthy fats in moderation, rather than simply avoiding carbohydrates and eating fatty foods indiscriminately.

3. Obesity Surgery

Can the scalpel fix what the Atkins diet won't? That's what millions of Americans are hoping. Demand for gastric bypass and other types of weight-loss surgery has skyrocketed, with the number of surgeries quadrupling over the past five years. In 2004 it's estimated that over 100,000 people will go under the knife in hopes of dramatic weight loss. New laparoscopic and endoscopic techniques are making the procedures easier and the recovery from surgery more rapid, but a number of recent news reports remind us that the procedures are not 100 percent safe. In fact, experts continue to caution that one in every 200 to 300 patients will die as a direct result of obesity surgery.

4. New Medicare Prescription-Drug Benefit

For the 40 percent of seniors without any prescription-drug coverage, the new Medicare bill will ease the economic burden of paying for their medicines, at least in the short run. But the legislation that was passed and signed by President Bush has many other important aspects that may offset the gains in prescription-drug coverage. The new legislation does not deal with the problem of increasing prices for prescription drugs, and the Medicare payment plan has large gaps in coverage. The real impact of the new law will take several years to sort out.

5. Congress Passes a New Law to Promote Safe Drugs for Children

Children need to have the best drugs available to treat their illnesses, but those drugs must be properly tested for pediatric use rather than just prescribed and sold based on adult testing. Many of the drugs we give to children have never been formally studied for use in children. New federal legislation changes all that, and should improve the quality of health care for our children. The Pediatric Research Equity Act of 2003 gives the U.S. Food and Drug Administration clear authority to require that pediatric studies of drugs be performed when needed to ensure that they are safe and effective for children.

6. Hypertension Guidelines Expand

New guidelines encourage more aggressive drug treatment of hypertension, acknowledging that most people need two or more drugs in order to bring their blood pressure down to safe levels. A new diagnosis of "prehypertension" was established for people with blood pressure numbers that are mildly elevated above ideal values. For these individuals whose top number (systolic blood pressure) is at or over 120 millimeters of mercury or whose bottom number (diastolic blood pressure) is at or over 80, doctors now recommend exercise and a low-salt, heart-healthy diet such as the DASH diet.

7. The Case of Terri Schiavo: Meaningful Life or Hopeless Limbo?

Terri Schiavo suffered brain damage in 1990 and has required tube feedings to keep her alive in a persistent vegetative state. Her husband and parents interpret the situation and Terri's wishes very differently. At the husband's legal request, tube feedings were discontinued. However, the Florida legislature quickly passed a law allowing the Governor to intervene, and the feedings resumed. While Terri Schiavo's fate remains unresolved for now, her case has renewed discussion and debate about the definition of meaningful life, the right to die, the rights of family members to make health-care decisions for loved ones who are unable to decide for themselves, and the government's role when family members disagree.

8. Hormones for Menopause - Symptom Treatment, Not Prevention

Estrogen as part of hormone-replacement therapy is no longer recommended as primary prevention for osteoporosis, heart disease and stroke. Additional data from the Women's Health Study increased the concern about risks of breast cancer, heart attack and blood clots. But for treating the menopausal symptoms of hot flashes, flushes and vaginal dryness, estrogen remains most effective. Women using estrogen therapy for symptom relief are encouraged to use the lowest dose possible for the shortest period of time.

9. The "Polypill" Might Cut Heart Disease by 80 Percent

A group of researchers suggest that one "polypill" per day for healthy people over age 55 could result in a tremendous reduction in heart disease. The proposed polypill combines six commonly used agents. It would include three drugs that reduce blood pressure (a thiazide diuretic, a beta-blocker, and an ACE inhibitor), aspirin to prevent blood clots, a statin to reduce cholesterol, and folic acid to lower homocysteine levels. The reaction of experts was surprisingly positive. These drugs are all inexpensive, and have low side-effect rates at the dosages proposed. The next step is to prove it works by running a clinical trial.

10. Flu Season Starts Early

The influenza season started early in many states. Of the unexpected high numbers of cases reported, children and pregnant women seem to be hit the hardest. More people than ever are now scrambling to find flu vaccine. The possibility of a severe flu season and the deaths from flu in children changed the minds of millions and blew away estimates of the vaccine supply needed for the United States. Vaccine supplies have run out in many parts of the country. It is not clear whether the 2003-2004 flu season will become a significant epidemic or whether we are just seeing an early peak of cases along with an increase in testing, diagnosis and reporting of flu cases.