2024 was a good year for medical progress. But that alone won’t save us.

In the health and medicine field, 2024 will be remembered for advancements in the prevention of HIV, a notable drop in the rate of obesity in the U.S., the murder of an insurance company CEO that unveiled the frustrations from Americans denied recommended medical treatments, and multiple attempts to supplant medical expertise with political maneuvering.

First the good news: In July, the New England Journal of Medicine published a phase three randomized clinical trial demonstrating the efficacy of a twice-yearly subcutaneous injection of lenacapavir in preventing HIV infection among cisgender women; a second trial published in November showed similar results among men and gender-diverse persons. The drug was named Science magazine’s 2024 “Breakthrough of the Year” for its remarkable efficacy and its innovation in targeting the capsid protein of HIV.

This single drug may not only prevent millions of HIV cases but also provide a model for the treatment of other types of viral infections. How effective will it be in real-world settings? That depends on making it obtainable for populations everywhere.

Use of glucose-like peptide-1 analogs (GLP-1s), the relatively new diabetes/weight loss drugs, skyrocketed in 2023, and, according to a JAMA Health Forum study published earlier this month, U.S. obesity rates dropped for the first time in a decade. As my colleague Jeremy Faust argues, it’s feasible that GLP-1s are responsible for this drop. Greater experience with the medication will answer the question of its direct impact on not only diabetes and obesity, but also a host of other chronic illnesses that are dominant causes of morbidity and mortality in the U.S.

How to reform our administratively heavy, expensive, inaccessible and underperforming health care system is a continual source of debate, but insurance companies received intense public scrutiny following the Dec. 4 murder of United Healthcare’s CEO, Brian Thompson. I’m generally familiar with the experiences of physicians and patients frustrated by insurance peer review and prior authorization processes. But the personal narratives on social media about being denied coverage were breathtaking in their number and scope and conveyed the shattering impact of care denials on people’s lives.

To be clear, Thompson’s murder was inexcusable. Still, it’s critical we have a public dialogue about the role insurance companies play in health care decisions. The current state of affairs is untenable: Denials are typically unrelated to medical necessity but instead grounded in administrative complexities. According to KFF, “In 2021, HealthCare.gov consumers appealed less than two-tenths of 1% of denied in-network claims, and insurers upheld most (59%) denials on appeal.”

Since the U.S. Supreme Court overturned Roe v. Wade in 2022, 21 states have enacted legislation to severely limit or ban abortion, and this year we learned more about the health impacts of these changes. Data released this fall showed that maternal and infant mortality in Texas, where some of the most restrictive bans have been enforced, are on the rise. Practicing physicians are migrating out of restrictive states, threatening all reproductive care in certain regions of the country.

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‘I think we’re in a moment of reckoning… people are angry with the state of U.S. healthcare’ December 21, 2024 / 07:11

This year also provided more examples of the single-minded, destructive nature of the effort to undermine abortion as a health service. Launching challenges to the Emergency Medical Treatment and Labor Act (EMTALA), designed to provide a minimal safety assurance to patients seeking emergency services, as well as the U.S. Food and Drug Administration’s regulatory process, abortion opponents showed us there’s no structure or statute too foundational for them to bulldoze in the name of derailing abortion access.

Overreach into health practices is not limited to abortion care. Earlier this month, the Ohio Legislature came dangerously close to passing a bill designed to compel hospitals to administer off-label medications even if their pharmacists and physicians are opposed on clinical grounds. The goal was to promote the use of ivermectin as a treatment for Covid, despite its poor performance in clinical trials. In Louisiana, meanwhile, four employees with the state’s Department of Health told NPR that the department had verbally implemented a policy to prevent its employees from encouraging the public to get Covid, flu or mpox vaccines. Preventing illness, which includes promoting the use of vaccines, is a core function of any public health agency.

There’s never a good time for undermining public health, but a number of looming threats make it particularly critical to have the best of science, medicine and public health on hand right now. Pertussis (whooping cough), measles and syphilis are all making a comeback. In August, the World Health Organization declared mpox a public health emergency of international concern, its highest level alert. H5N1, the “bird flu” around for two decades, has killed millions of poultry and infected other species, including dairy cattle, domestic cats, sea mammals and humans. Even if it doesn’t make the leap to human-to-human transmission, the virus already constitutes, according to University of Washington researchers, “a threat to biodiversity and the health of ecosystems, which we have learned is extremely important for human health.” 

If there is an overarching theme to the past year, it’s that scientific progress marches on, but not even the best innovations can save us if we don’t attend to the last mile: ensuring everyone can receive their benefits. There are too many forces that serve as barriers to access, including not only cost and availability, but misinformation and politicization of health services. Societal breakthroughs against these forces would allow us to realize the full potential of our incredible scientific advances.