Unfortunately, in almost half these cases, fibroids re-
turned. Nevertheless, the issue of research into alter-
native treatments for bleeding or fibroids was
brought to the public’s attention.
Infectious Disease The last “natural” case of polio-
myelitis in the United States had been diagnosed in
- The introduction of the first inactivated polio-
myelitis vaccine developed by Jonas Salk in the mid-
1950’s, subsequently followed by the oral poliomy-
elitis vaccine developed by Albert Sabin in the mid-
1960’s, had resulted in control of what had been an-
nual devastating epidemics. The last case of polio in
the Western Hemisphere occurred in Peru in 1991,
and in 1994 the Pan American Health Organization
within the World Health Organization announced
the eradication of the disease in the West. Both Salk
and Sabin died during the decade, Salk in 1995 at
age eighty, and Sabin in 1993 at age eighty-six.
Meanwhile, a newly recognized disease appeared
in the southwestern United States in 1993. In March,
the first case of acute respiratory distress syndrome
(ARDS) was diagnosed in the Native American area
near the Four Corners region. By June, sixteen pa-
tients, twelve of whom had died, had been diag-
nosed, with another twenty-five persons likely in-
fected. In the period between 1993 and 1995, forty-
five deaths were attributed to the infection. The etio-
logical agent was identified in 1993 as a member of
the hantavirus group, first described during the Ko-
rean War. The reservoirs for the agent were the deer
mouse and cotton rat, as well as other regional ro-
dents. Isolated infections by the same family of vi-
ruses were subsequently reported in other regions of
the country.
While stomach ulcers were not normally classified
as infectious illnesses, Australian gastroenterologist
Dr. Barry Marshall proposed in 1983 that a bacte-
rium he had isolated from the stomachs of patients,
Helicobacter pylori, was the likely agent underlying de-
velopment of ulcers. Marshall’s work was confirmed
by others during the 1990’s, resulting in possible
treatment of ulcers using antibiotics.
The first examples of “extensively drug-resistant”
(XDR) cases of tuberculosis were reported in the
United States during the 1990’s. Between 1993 and
1999, over 111,000 culture-confirmed cases of the
disease were reported by the National Tuberculosis
Surveillance System (NTSS). Thirty-two of these
cases were due to infection by XDR strains ofMyco-
bacterium tuberculosis. Antibiotic-resistant strains of
other bacteria were likewise becoming an increasing
problem. In 1996, vancomycin-resistant strains of
Staphylococcus aureus, previously found to be resis-
tant to other commonly used antibiotics such as
methicillin, were isolated from infected patients.
The incidence of acquired immunodeficiency
syndrome (AIDS) in the United States peaked in the
mid-1990’s, with 257,000 cases reported between
1993 and 1995. Approximately 600,000 cases were
reported during the decade, though the numbers
were inflated from the previous decade in part as a
result of redefining the disease to include additional
opportunistic infections. In 1996, the incidence of
new cases began to decline, in part the result of in-
creased emphasis on altering risk behaviors. Ap-
proximately two-thirds of persons diagnosed with
AIDS since its recognition in 1981 had died by the
end of the 1990’s. Among the persons diagnosed in
1991 as being HIV-positive was Los Angeles Lakers
basketball player Magic Johnson. However, in 1996,
the first of a new generation of anti-human immu-
nodeficiency virus (HIV) drugs was introduced
and approved by the Food and Drug Administra-
tion. A series of protease inhibitors received “fast-
track” approval and were incorporated into drug
cocktails, combinations of anti-AIDS drugs acting at
different targets of viral infection. Despite the devel-
opment of new forms of treatment, the isolation of
a drug-resistant virus was reported by the end of
the decade.Cancer The incidence of breast cancer in women
continued to rise during the 1990’s, surpassing 100
cases per 100,000 women, with approximately 180,000
cases diagnosed annually; by age eighty-five, a woman
had one chance in eight of developing the disease.
However, the “good” news was that the death rate at-
tributed to breast cancer in women declined by
greater than 6 percent, with a decline of nearly 10 per-
cent in women under the age of sixty-five. Several ex-
planations accounted for these results. First, empha-
sis on early detection resulted in earlier diagnosis
and treatment. The proportion of women who re-
ported having undergone a yearly breast examina-
tion, including mammography, increased to nearly
40 percent, a tenfold increase when compared with
surveys in the 1970’s. Improved treatment also had
an impact. For example, use of the hormone
tamoxifen was found to reduce by 40 percent the558 Medicine The Nineties in America