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CNN Presents: Top 25 Medical Stories of 25 Past Years

Aired February 13, 2005 - 20:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


RANDI KAYE, HEADLINE NEWS, CNN CENTER ATLANTA: Hello, I'm Randi Kaye. CNN 25 is next. First, here's what's happening now.
Police in Ulster, New York are holding a suspect after a shooting in a crowded shopping mall. Two people are injured, one of them shot. This is a live picture outside the mall. The gunfire sent shoppers fleeing for safety.

Police say mall staffers overpowered the gunman when he ran out of bullets.

(BEGIN VIDEO CLIP)

CHIEF PAUL WATZKA, ULSTER, N.Y. POLICE DEPT.: The subject entered the Best Buy, started firing while walking through Best Buy. When he exited Best Buy into the corridor, that's when he was apprehended by a couple of the employees at the mall.

(END VIDEO CLIP)

KAYE: Tonight at 10:00 Eastern, the United Iraqi Alliance has won a plurality of the vote in Iraq's elections. That's good news for former Bush White House ally, Ahmed Chalabi. He ran with the majority Shiite Party. We'll get his take at 10:00 Eastern on CNN SUNDAY NIGHT.

More headlines in 20 minutes. Next, the top medical stories from 25 years of CNN.

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Twenty-five years and 25 stories that changed our world and our health.

It was once called a gay disease, but before we knew it, it belonged to all of us, everywhere, the epidemic in our backyard.

Then, years of lies about lighting up. How the little people made big tobacco pay.

Plus the mad cow that roared and made us look at our burger a bit differently.

And finally, changing what you don't like about yourself with a nip and a tuck, and a big ole price tag.

We're counting down the stories that made us healthy, wealthy and wise. Welcome to CNN's TOP 25. I'm Dr. Sanjay Gupta at Emory Crawford Long Hospital in Atlanta. This month our focus is the top medical stories of CNN's first 25 years.

People are living longer and healthier lives, thanks in part to the medical advances that we watched unfold right here on CNN.

Twenty-five years ago, no one had heard of HIV AIDS. Cloning was science fiction. And low carb was low profile.

We asked a panel of doctors to look at the major medical events CNN has covered over the years and come up with a list of the stories that shaped our health and changed our lives - for better or for worse.

DR. RANDY MARTIN, EMORY SCHOOL OF MEDICINE: We thought about things that have really advanced the science of medicine, advanced the caring of medicine and really have made an impact on people's lives.

GUPTA: Now that you know the prescription for the program, let's get it started, with an accidental discovery that impacted the sex lives of men and women around the world and became a punch line for late night TV. Here's No. 25.

A little blue pill starts off our list at No. 25. A little blue pill known as Viagra. Approved by the FDA in 1998, Viagra was brought to the market by Pfizer to treat erectile dysfunction, or ED. Yet that wasn't the original goal of Viagra.

Pfizer scientists were researching ways to treat heart conditions, and during trials noticed the unforeseen benefits for men suffering from ED. So the company turned the focus of the drug away from heart ailments, and Viagra was born.

At No. 24, Tylenol tampering, 1982. The nation was panicked after someone, who was never caught, injected cyanided into Tylenol capsules, killing seven. The company responded within days, recalling 31 million bottles in an unprecedented move. And it led to tamper- resistant consumer product packaging for many over-the-counter drugs, and a more prevalent use of caplets.

Hyperactivity, impulsiveness and a lack of attention span in children doesn't seem out of the ordinary, right? Yet for those kids who don't grow out of it, the four letters of the No. 23 selection on our list might be the answer - ADHD.

DR. WILLIAM T. BRANCH, EMORY SCHOOL OF MEDICINE: ADHD is Attention Deficit Hyperactivity Disorder, a disorder of children whereby they tend to be hyperactive. And also, they have difficulty in paying attention, organization, a kind of inability to complete a project - and difficulty in learning for those reasons.

GUPTA: ADHD was formally recognized in 1987 by the American Psychological Association as a medical diagnosis. Estimates from the National Institutes of Mental Health put between three and five percent of kids as having ADHD. As to what causes ADHD, that's still being studied, with the focus less on the effects of parenting, and more on the biological triggers in the brain.

It's been nearly 20 years since the world first heard the term mad cow disease. Since then, it's been a crisis that has crossed borders and claimed lives. And even though the number of known cases has plummeted, there are still many unanswered questions when it comes to mad cow.

Rick Sanchez explains.

(BEGIN VIDEO CLIP)

RICK SANCHEZ, CNN NEWS ANCHOR: The image of a staggering cow is one few people can forget. And not just for the graphic nature, but for the worldwide impact it would have on human health. Bovine spongiform encephalopathy first reared its ugly head in Britain, November 1986.

The degenerative disease attacks the cow's nervous system, causing changes in temperament, loss of coordination and eventually death. The U.K.'s epidemic led to the slaughter of more than three million cattle.

DR. LINDA DETWILER, FORMER OFFICIAL, U.S. DEPARTMENT OF AGRICULTURE: People didn't realize the implication that it would have.

SANCHEZ: At first it was an obscure medical term that most people wouldn't even be able to pronounce. But then, when people contracted the disease from eating tainted beef, the term mad cow would become a global, household word.

In 1996, British scientists announced the discovery of variant Creutzfeldt-Jakob disease - the human form of mad cow. The brain- wasting disorder has claimed nearly 160 lives across the globe, more than 90 percent of those occurring in the United Kingdom.

But perhaps most disturbing is the list of unknowns that still exist for this incurable disease.

GEORGE GRAY, EXECUTIVE DIRECTOR, HARVARD CENTER FOR RISK ANALYSIS: There's evidence right now that blood transfusions may be able to spread the variant form of CJD - vCJD, the human form of mad cow disease - from person to person.

SANCHEZ: Scarier still is this. This disease can lie dormant in your system for as long as 30 to 40 years.

DR. ERMIAS BELAY, MEDICAL EPIDEMIOLOGIST, CENTERS FOR DISEASE CONTROL AND PREVENTION, ATLANTA: Now because of, as you say, the long incubation period, it's possible that there are patients who are infected and are carrying the agent without showing the signs and symptoms. SANCHEZ: The United States had its own brush with mad cow when an infected cow turned up on U.S. soil in 2003. Turns out, the cow actually was from Canada, where two more infected animals have been uncovered, leading some researchers to believe there is still work to be done.

DETWILER: I think it's critical that both Canada and the United States maintain this high level of surveillance, so that we understand exactly how much disease is out there.

SANCHEZ: However, most experts say, the risk to American citizens is minimal at best.

DR. GARY WEBER, EXECUTIVE DIRECTOR, REGULATORY AFFAIRS, NATIONAL CATTLEMEN'S BEEF ASSOCIATION: I think BSE is going to go down in the next 25 years as a disease that once existed.

(END VIDEO CLIP)

GUPTA: In 20/20 hindsight, the No. 21 item on our list couldn't be clearer. Laser eye surgery burned onto the scene in 1988, when the first successful surgery to correct a patient's vision was performed.

MARTIN: For those individuals that are severely nearsighted - the ones who have been called wearing Coke-bottle-bottom glasses - this was a dramatic advance, because it really changed lives.

It made it so that people could see things in the dark, so that they could have proper employment - and you think of firefighters and people like that.

The ability to correct severe nearsightedness - and that's really what LASIK eye surgery was all about - was really a dramatic advance.

GUPTA: Burning big tobacco. Smoking? Still to come, how smokers turned the tables on companies who had torched the truth for decades. And ...

UNIDENTIFIED MALE: We're going to be paying the costs of the complications of this disease, well into the next three or four decades.

GUPTA: Step on the scale to see what's weighing heavily on our world, as we continue CNN's TOP 25.

(COMMERCIAL BREAK)

GUPTA: Many U.S. couples who had been unable to have babies got an assist in 1981 from No. 20 on our list - ART, or assisted reproductive technology.

MARTIN: In vitro fertilization is really an interesting concept. It really involves taking an egg from a woman and the sperm from a man, mixing them in a dish, getting an embryo - and then putting that back inside the woman to produce a baby. The option to use in vitro fertilization opened up the opportunity for a lot of people and a lot of couples who want to have babies.

GUPTA: From the delivery room to the courtroom for No. 19. Silicone implants from Dow Corning were commonly used in plastic surgery for women undergoing breast augmentation during the early '80s. But due to adverse effects of leaking implants, the company was forced to pay a multi-billion-dollar settlement brought by nearly 170,000 women.

BRANCH: The Dow settlement definitely changed the use of implants for breast augmentation. Basically, silicone was taken off the market, and it was replaced by saline implants.

GUPTA: The deadly dangers of cigarettes are nothing new. Still, more than a fifth of all Americans smoke. And smoking related illnesses cost the U.S. health care system as much as $75 billion a year.

Ali Velshi takes a look at the death and dollar signs that inspired No. 18.

(BEGIN VIDEO CLIP)

ALI VELSHI, CNN BUSINESS CORRESPONDENT: It was the mid-'90s. Cash-strapped states wanted to recoup the massive health care costs linked to smoking. The cigarette industry had money, but the states would have to prove that smoking was dangerous and addictive - charges that big tobacco had beaten back before.

I'm holding a copy of the 1890 edition of the U.S. Pharmecopeia, the most comprehensive listing of drugs in the United States. Well, you can see that tobacco appears here, but it didn't appear in the 1900 edition.

Well, a few years after that, the first law to regulate drugs in the United States was passed using the Pharmacopeia of the time as a guide to what was and wasn't a drug. Tobacco got a free pass.

A hundred years later, tobacco is still not considered a drug. But the Food and Drug Administration has argued that it should regulate tobacco products.

Former chief David Kessler recalls the warning from his advisors.

DR. DAVID KESSLER, FORMER COMMISSIONER, U.S. FOOD AND DRUG ADMINISTRATION: It's political suicide. It's a fools errand. It's the big muddy. Yes, it's the right thing to do, but the industry is too powerful.

VELSHI: The Supreme Court ruled against the FDA. But in 1998, big tobacco settled the states' case against it for nearly $250 billion. A pack of smokes went up 45 cents to pay that bill.

But where did the settlement money go? The states have only directed about a third of it to smoking-related health care. Only about five percent of the payout has gone to smoking prevention.

Tobacco giant Philip Morris admitted in 1999, that smoking is dangerous, and it's increased its spending on anti-smoking initiatives.

PEGGY ROBERTS, PHILIP MORRIS USA SPOKESWOMAN: We've paid the states over $18 billion. And we spent - we've spent well in excess of half a billion on youth smoking prevention.

VELSHI: But promotional spending in the cigarette industry overall is up - way up - from $6 billion a year in 1998 to $12 billion a year now.

How much would you say, as a percentage, do you spend on the youth smoking, anti-smoking initiatives versus promotions?

ROBERTS: I don't know the answer to that.

VELSHI: You sure?

ROBERTS: I really don't know that answer to that.

VELSHI: I bet it's a lot less.

ROBERTS: Probably, yes.

VELSHI: The U.S. Surgeon General now says smoking causes disease in nearly every organ of the body. And second-hand smoke? Nearly 800 municipalities have now banned or restricted public smoking.

In some 300 cities and towns across America, you can't even light up in a bar or a restaurant.

Today, fewer Americans do smoke and fewer teenagers are picking up the habit. Back in 1998, 3,000 teenagers started smoking every single day. Today only 2,000 will pick up the habit - only 2,000.

KESSLER: If we can get a young person to 18, 19 or 20, and they have not begun to smoke, it is unlikely that they ever will begin.

GUPTA: Potential side effects of No. 17 on our list, include increased knowledge of previously obscure medical conditions and the colorful drugs that treat them.

Direct-to-consumer marketing of prescription drugs began in 1997, as the FDA relaxed regulations as to how pharmaceutical companies could approach consumers.

BRANCH: My own opinion on direct-to-consumer marketing of brand name drugs is that it has been both good and bad. It has the potential to educate the public.

GUPTA: But Branch says some advertising goes too far and becomes misleading.

BRANCH: The extent that it misleads the public in some way, it is a danger. And I certainly they need - the FDA needs to continue to regulate these ads.

GUPTA: Coming in at No. 16, the 1999 outbreak of West Nile virus, the first ever in the United States.

DR. JULIE GERBERDING, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION, ATLANTA: At the very beginning of West Nile, it started in Manhattan the first year. And then it moved down the eastern seaboard the next year.

GUPTA: Evidence of West Nile has now been found in every U.S. state except Alaska and Hawaii, according to the federal government.

In the wake of September 11th, it was the terror that could show up in our mailbox.

LEROY RICHMOND, ANTHRAX SURVIVOR: I've never in my life been this sick before.

GUPTA: A quiet killer that could be mistaken for the flu.

And it's not who you are, it's how you look. Get a new nose, a new chin, a new grin - but keep your eyes on CNN's TOP 25. Stay tuned.

(COMMERCIAL BREAK)

GUPTA: Ninety-nine billion letters are sent through the U.S. Postal Service every year. And every day, Americans bring letters like these into their homes and tear them open.

But what if those envelopes contained a powder that could kill you?

(BEGIN VIDEO CLIP)

TOMMY THOMPSON, FORMER SECRETARY OF HEALTH AND HUMAN SERVICES: The Centers for Disease Control has just confirmed the diagnosis of anthrax.

JEANNE MESERVE, CNN NEWS CORRESPONDENT: It as a shocker and a killer. When all was said and done, five were dead, 22 became ill. One of them was postal worker Leroy Richmond.

LEROY RICHMOND, ANTHRAX SURVIVOR: My breathing became shallow. There was constriction in my chest. I had this pounding headache.

MESERVE: The method of attack could not have been more mundane - everyday envelopes addressed to members of Congress and media outlets.

The anthrax shut down Capitol Hill, caused partial paralysis of the male system, terrified the nation. And more than three years later, we still don't know who sent it.

REP. CHRIS SHAYS, (R) CONNECTICUT: Our best chance of catching this individual is when they do it again. And that's the last thing we want to happen. MESERVE: The anthrax attack shut down this postal facility in Washington, D.C. for two years. What if it did happen again? Would the nation be better prepared?

THOMAS DAY, VICE PRESIDENT OF ENGINEERING, U.S. POSTAL SERVICE: If anything were escaping, it's going to be drawn into the filter.

MESERVE: At processing centers, the Postal Service has installed ventilation systems intended to capture any substance escaping from a letter, and biological detection systems to identify anthrax.

DAY: It's reliable, and it's very sensitive.

MESERVE: But in the health arena, bioterrorism experts say, there is much more to be done.

DR. THOMAS INGLESBY, CHIEF OPERATIONS OFFICER, CENTER FOR BIOSECURITY, UNIVERSITY OF PITTSBURGH MEDICAL CENTER: Three-and-a- half years later, we still don't have any rapid diagnostic test, to be able to distinguish an anthrax-infected patient from somebody who has the flu.

MESERVE: Once it is diagnosed, physicians have learned rapid treatment with antibiotics can have a huge impact.

RON BROOKMEYER, JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH: If we could get antibiotics to people within six days, we could prevent 70 percent of cases.

MESERVE: The nation has stockpiled enough antibiotics to treat two major metropolitan areas, but a drug-resistant strain of the bacteria could make them useless.

A next-generation vaccine is in production. The government expect to take delivery of 75 million doses by November of 2007. And further innovations may be ahead.

INGLESBY: It's imaginable that people could have in reserve patches that contain anthrax vaccine. In the event of a crisis in America, people simply get out the patch and slap it on their arms.

MESERVE: The most significant after-effect of the anthrax attacks, experts say, may be that physicians are better trained to recognize anthrax - if this ever happens again.

(END VIDEO CLIP)

GUPTA: Cystic fibrosis, muscular dystrophy, sickle-cell anemia - all hereditary conditions for which traditional medicine has provided no cure.

But some see potential in No. 14 on our list - gene therapy.

BRANCH: Gene therapy in humans is asserting a gene into a diseased organ or tissue, and thereby correcting the disease by inserting a healthy gene. GUPTA: The first authorized gene therapy was successful in 1990, treating two Ohio girls suffering from the lack of an immune system, who remain healthy today. Yet the death of a teenager in the late 1990s during a trial prompted a slowdown, as researchers continue to test the most effective ways to apply the therapy.

If you weren't born with a perfect face or body, lucky No. 13 can help you change all that. As Elizabeth Cohen reports, millions of Americans are willing to undergo the knife to change the way they look - and feel.

(BEGIN VIDEO CLIP)

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: In a world of extreme makeovers and swong (ph) ...

UNIDENTIFIED MALE: A team of plastic surgeons will turn these 16 average women into drop-dead beauties.

COHEN: Plastic surgery experts say these reality shows - telling people they can change anything they don't like about their appearance - are fueling a boom in cosmetic surgery.

More cosmetic procedures are performed in the U.S. than in any other country, according to the International Society of Aesthetic Plastic Surgery. In 2003, that number topped 8.3 million. That's a 20 percent increase from 2002, and a 293 percent increase in the total number of cosmetic procedures since 1997.

DR. MILES GRAIVIER, PLASTIC SURGEON: And I think with the reality shows on plastic surgery, the numbers are going to be exponentially higher.

COHEN: But before these shows made their way into prime time, it all started with images like this - and this. Breast augmentation, liposuction and tummy tucks to suck the fat, face lifts, nose reshaping and eyelid surgery are the most popular surgical procedures.

People are also opting to make their hands look younger and their feet more comfortable in their high-fashion shoes. And it seems like everyone is doing it.

LYNNE LUCIANO, SOCIAL HISTORIAN: Everybody is getting on the band wagon - all ages, all income levels, all ethnicities.

COHEN: While women represent the majority, the number of men is on the rise.

GRAIVIER: It's not a stigma any more to go in - even for a man - to have some type of cosmetic surgery procedure.

COHEN: Mexico and Brazil come in second and third for the number of procedures they perform, and some Americans even travel there to get a vacation while they recover from their nip and tuck.

In China, there are more than one million cosmetic surgery clinics. The country even hosts a Miss Plastic Surgery pageant. The only requirement for the participants is that they've gone under the knife.

Safety issues plagued the industry in the 1990s. Fear over leaking breast implants led to a ban on silicone. Saline's an alternative. And newer materials - such as cohesive gel, which some say are safer - are under consideration by the U.S. Food and Drug Administration. They could get approval later this year.

There were even deaths from liposuction, blamed on the removal of too much fat and centers ill-equipped to handle what went wrong during surgery.

But with new technology and some safer procedures, that's all changing. Less invasive surgeries are an option, promising a shorter recovery, getting patients home and even back to work within days.

DR. BRIAN KINNEY, PLASTIC SURGEON: The emphasis is on minor procedures, smaller procedures, quicker return to work.

COHEN: And there's a move toward simplicity. Over six million non-surgical cosmetic procedures were performed in 2003.

Plastic surgeons say patients are now opting for classical features.

KINNEY: People coming in and say, I don't want to be extreme, and I don't want to be made over. I want to be subtle, I want to be natural.

COHEN: Perhaps cosmetic procedures are creating a new natural.

(END VIDEO CLIP)

GUPTA: The low carb craze is next on our countdown at No. 12. Whether the supermarket or eating out, low carb options are everywhere.

The low carb lifestyle became all the rage with the emergence of the Atkins Diet in the '80s. The Zone, Sugar Busters and the South Beach diets continued the carb-cutting trend.

MARTIN: I think people would say that it is a fad. What we're realizing - and what we've known for quite a while - is that you have to have the right kind of carbohydrates, the right kind of fats. You have to watch calories. You have to watch portion size.

GUPTA: At No. 11 is phen-fen, the so-called magic weight loss pill.

Phen-fen is a combination of two drugs - fenfluramine, an appetite suppressant, and phentermine, a mild stimulant. Combined, they create a powerful diet drug.

But the popular combo disappeared from the marketplace after the FDA asked the manufacturer to withdraw one of the drugs in the combination.

MARTIN: The FDA actually began an investigation, and said that we should really not use these medicines as weight loss. And so, it really goes back to the old thing, you've got to have lifestyle changes.

GUPTA: Twenty-five years ago, no one had heard of it.

UNIDENTIFIED MALE: I didn't really anticipate that we would have one of the most devastating, if not the most devastating, global pandemic in history.

GUPTA: Now, millions around the world live with it, and fight against it. Coming up.

And tipping the scales on another kind of epidemic. But this one has a cure. Stay tuned to CNN's TOP 25.

(COMMERCIAL BREAK)

KAYE: Hello. I'm Randi Kaye, CNN 25 continues in a moment. First the latest headlines. A group made up of Iraq's majority Shiites has more votes than any other party in the national election but results announced today show it falling short of an outright majority. Out of some 8 million voters, the United Iraqi Alliance tops at about 47 percent. The Kurdish coalition won about 25 percent and the Iraqi National Accord is at 13.6 percent.

Police say they believe a 24-year-old man was acting alone in a shooting spree inside a shopping mall in Ulster, New York. The suspect is in custody. Officers say mall employees jumped him when he ran out of ammunition. Two people were injured, one by the gunfire.

On a happier note, Valentine's Day is tomorrow. Noted sex therapist Dr. Ruth Westheimer (ph) joins us with advice for the occasion at 10:00 Eastern on CNN SUNDAY NIGHT.

That's our latest. Next, more top medical stories from 25 years of CNN.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Welcome back to CNN's top 25. I'm Dr. Sanjay Gupta and we're counting down the top medical stories of the past quarter century. Hospitals like this one have changed to accommodate new diseases and health problems never even imagined just 25 years ago. Before the break, we were looking at body image and the quest to stay thin. But in staying with the theme, number 10 takes the bathroom scale one step further.

Do you know your BMI? Put down the fork and pick up the weights at number 10, knowing your BMI may be the key to better health.

DR. RANDY MARTIN, EMORY SCHOOL OF MEDICINE: BMI stands for the body mass index and why it came about is that it was a way to really tie your weight, height complex, the body mass index, to your potential risk for developing diseases, because the higher your BMI, the more likely you were to develop diabetes, osteoarthritis and even cancers.

GUPTA: So how do you calculate it?

MARTIN: If you take your weight in pound and divide it by your height in inches squared and multiply it by 703, then you'll get your BMI and BMI is an excellent way for most of us to judge where do you stand in an idea weight and are you at risk for developing diseases?

GUPTA: In a nation of super sized fries, there are now super sized people. One in three American adults is considered obese, with the BMI of 30 or more and with obesity becoming more prevalent, comes a whole new set of health problems. Holly Firfer tallies the issue of weight at number nine.

HOLLY FIRFER, CNN CORRESPONDENT: Big, bigger, deadly. This year, complications of obesity will kill an estimated 365,000 Americans. This is not just losing 10 pounds you gained over the holidays. We're talking about an obesity epidemic, 59 million people whose lives are at risk, according to the Centers for Disease Control and Prevention, because they need to lose weight.

DR. WILLIAM DIETZ, CENTERS FOR DISEASE CONTROL AND PREVENTION: Obesity is the epidemic of the century. Over 30 percent of adults in this country are obese, defined as a body mass index greater than or equal to 30. Our concern about this problem is that obesity is the major cause of heart disease, Type II diabetes and cancer.

FIRFER: It's not just a matter of too many adults visiting the fast food drive throughs. Since 1980 according to the government, obesity rates have doubled among children and tripled among adolescents. The problem, high fat, high calorie foods and physical inactivity, byproducts of a high tech, coach potato lifestyles.

Remember this guy? Morgan Spurlock (ph). He put a fast food giant to the test by eating nothing by McDonalds for a month. The result: he gained 25 pounds. He went from the picture of perfect health to a medical basket case but it was a box office hit.

Even though Americans are so obsessed with dieting that it's become a $40 billion a year industry, we are fatter than ever.

ADELE MILLER, WEIGHT WATCHERS MEMBER: Just sort of crept up on me. I gained what, maybe one or two pounds a year. Over time that turned into like 30 pounds and that was very, (INAUDIBLE) a lot of weight for me. I could feel it. I started snoring. I started having heartburn. I started having pains in my knees.

LORRAINE RUSSELL, WEIGHT WATCHERS MEMBER: My (INAUDIBLE) weight is, let's just say I have 112 pounds to lose to get there.

FIRFER: So what is an ideal target weight and who sets the standard? The government does. The National Institutes of Health defines overweight as an increased body weight in relation to height. Let me give you an example. I'm 5 foot 3 and about 118 pounds. If I gained just 18 pounds or something about the weight of a bowling ball, I would be overweight. Make that 51 pounds or about the weight of 2 1/2 bowling balls, I would be considered obese.

It's not just a problem in this country. According to estimates from the World Health Organization, 22 million of the world's children under the age of five are over weight. The number of over weight adults according to these estimates has reached one billion worldwide. Nearly one third are classified as obese.

DIETZ: If we don't successfully prevent obesity, we're going to be paying the costs of the complications of this disease well into the next three or four decades and those costs are going to be the costs of heart disease, diabetes and cancer, all of which are linked to obesity.

GUPTA: As the countdown continues, buckle yourself in at number eight with the seat belt use law that was enacted in 1984 in New York. Laws vary from state to state. About half require all adults and older children to wear belts and for infants to be restrained in child car seats.

DR. WILLIAM T. BRANCH, EMORY SCHOOL OF MEDICINE: The seat belt law was enacted because of the unequivocal evidence that seat belts save lives. There's a great deal of positive things that come out of the seat belt law. Lives are saved. The community saves its resources that would be spent on treating people who would be more seriously injured.

GUPTA: At number seven is the widely used antidepressant drug Prozac. Since its introduction in 1986, Prozac has been used by more than 40 million people worldwide, more than 10 million for depression, making it the most popular antidepressant ever.

BRANCH: I think it became popular because in fact you could give the drug and there were very few side effects in most people. Also it seems to have somewhat more rapid onset of action against depression and it gives people more energy so it has this kind of activating effect.

GUPTA: But there are concerns about the drug.

BRANCH: There has been publicity about Prozac and the question that's been raised about that class of drugs is in whether they contribute to suicide. This is a controversial topic.

GUPTA: At number six, it's a medical first, 2001 doctors at Jewish hospital in Louisville, Kentucky implant the first self- contained mechanical heart. 59-year-old Robert Tools (ph) received a battery-powered aviacor (ph) heart.

MARTIN: He lived 151 days which is really, was very dramatic.

GUPTA: The softball sized device is designed to fully sustain the body's circulatory system while allowing recipients to maintain a productive lifestyle. But there are still major advances needed.

MARTIN: So while there's tremendous development being done, I think what we'll see is very small devices now that will sort of take over the pumping action of the heart and rest it and the heart repaired itself and then you remove them. So I think most of us believe that a totally artificial heart is still some ways out.

(COMMERCIAL BREAK)

GUPTA: We're closing in on the top five, but before we move on, let's look back at numbers 10 through six. Landing at number 10, body mass index. It's not just about how much you weigh, but what makes up that weight that matters.

Number nine, a nation with an appetite for food. Obesity is changing the face of America and America's health. Buckle up at number eight. Seat belts saving lives. Did you even know your car had seat belts in 1980? Then number seven, medicating your depression away with Prozac and at number six, the first self-contained artificial heart transplant.

And that brings us to number five and a transplant of another kind. The first successful living liver transplant makes it to number five on the list. Medical history was made in 1989 when Terri Smith donated a portion of her liver to her 21-month old daughter Allysa.

TERRI SMITH, ALLYSA'S MOM: I realize that part of me is in her now. Part of my liver is functioning as her liver.

GUPTA: The University of Chicago had just established a program of living donor liver transplantation to reduce the shortage of appropriate donors for infant recipients.

DR. CHRISTOPHER BROELESCH, ALLYSA'S SURGEON: I think it's an attempt in the right direction and I think it's going to change the face of (INAUDIBLE) liver transplantation.

GUPTA: Today, the technology used by the University of Chicago team has since become a building block for transplants.

No transplant or procedure can reverse number four. AIDS has no cure and no end in sight. It's estimated 14,000 people a day become HIV positive. Let's take a closer look at treating a disease that is all too often a death sentence. Dr. Bruce Rashbaum has been on the front lines of HIV for about 20 years as both a doctor and a patient.

DR. BRUCE RASHBAUM, NATL INSTITUTES OF HEALTH: In 1997 I took 20 pills. Other patients certainly could have taken more than that. Some people probably took 30 pills.

GUPTA: That was every day. Now HIV treatment has been so well refined, he and many patients like him are down to about three or four pills a day. But the fact that people like Rashbaum who were infected in the early days are even alive is quite significant.

The year was 1981 and here in the U.S., the first cases of a yet unnamed mystery disease began appearing in gay men.

DR. ANTHONY FAUCI, NATL INSTITUTES OF HEALTH: I didn't really anticipate that we would have one of the most devastating, if not the most devastating global pandemic in history.

GUPTA: 1982, the term acquired immune deficiency syndrome or AIDS is first used and within a year, researchers had determined it was the HIV virus that was destroying the patient's immune system and killing them.

CLEVE JONES, FOUNDER, AIDS QUILT: Every time I went out of my apartment, I would see people dying, people my age walking around on canes with no hair.

GUPTA: Then in 1996, things changed. A class of drugs called protease inhibitors were approved by the FDA. Doctors began to combine them with other HIV medicine into an AIDS drug cocktail and HIV was no longer considered a death sentence.

FAUCI: Certainly it's not a cure, but it was a dramatic turnaround.

GUPTA: But the drugs are expensive, so costing as much as $10,000 a year, financially out of reach for many of the estimated 40 million people worldwide who now have HIV AIDS. Although every continent has been hit, the vast majority are in sub-Saharan Africa and given the cost, for most there, HIV is still a death sentence.

DR. PETER PIOT, UNAIDS: We don't (ph) expanding prevention and treatment efforts in the developing world over the next decades, tens of millions of people are going to die.

GUPTA: Some experts say a vaccine is the only hope for stopping the disease, but so far, efforts to develop the vaccine haven't panned out. There's a saying among vaccine researchers. Follow the body's response, meaning mimic in the lab what the body does naturally to get rid of disease. But the problem is, of the more than 16 million people who have been infected with HIV, there is no known case of a single person getting rid of the virus.

FAUCI: If you don't have anybody recovering completely from HIV, then you don't have any blueprint for the way you want to go with your vaccine.

GUPTA: Without a vaccine, the spread of HIV is best reduced by treating those who have the disease.

FAUCI: I think we will for a very long time have a world with HIV but I think a world in which the epidemic is going in the opposite direction is within our grasp.

GUPTA: At number three is the controversial topic of cloning.

SEN. BILL FRIST (R) TENNESSEE: The first successful cloning of an adult mammal has captivated the attention of the world.

GUPTA: At the center of all the attention is Dolly. Cloned by Dr. Ian Wilmut and his team at the Roslin Institute near Edinburgh, she was born on July 5th, 1996. DR. IAN WILMUT, CREATOR OF DOLLY, ROSLIN INSTITUTE: There are a number of genetic diseases for which there isn't a cure at the present time, serious diseases and this will enable us to carry out research into the causes of those diseases and perhaps develop methods to treat them.

GUPTA: Dolly was put down in February of 2003 due to complications from a progressive lung disease. But should this research be used to clone a human? The ethical and scientific debate continues to rage today.

BRANCH: Well, I think there's one extremely practical concern with cloning humans. We don't really know what the effects are when you clone the DNA of an adult.

GUPTA: Just recently, the British government gave the Roslin Institute a license for therapeutic cloning which creates, then destroys human embryos as a source for stem cells to be used to help cure diseases, a method that many have questioned.

WILMUT: We have to demonstrate that it was not possible to do this research in any other way and I believe that that is true.

UNIDENTIFIED MALE: Ultimately, cloning will be used in one form or another and hopefully with adequate controls over all of the potential ill effects that might result.

GUPTA: Ethics also meets science in number two, embryonic stem cell research. The potential of tiny cells with enormous possibilities have been lost in a political argument, but not forgotten. Here's Elizabeth Cohen to shed some light on the story.

ELIZABETH COHEN, CNN CORRESPONDENT: They're perhaps the most controversial frontier in modern medicine. Many scientists believe these tiny cells hold the potential to treat diseases such as diabetes, Alzheimer's and Parkinson's and even spinal cord injuries. Celebrity sufferers have beaten a drum for exploiting stem cells.

MICHAEL J. FOX: I'm one of the million involuntary experts on Parkinson's disease in the United States. That (INAUDIBLE) destructive nature as we wait for a cure.

CHRISTOPHER REEVE: It's a miracle. It's something that has unlimited potential for curing people.

COHEN: The search for a cure became the life work of actor Christopher Reeve before he died in 2004. Embryonic stem cells are unspecified or blank cells. Scientists hope they can manipulate these cells into becoming any type of cell. For example, with some spinal cord injuries, broken vertebrae cut the bundle of nerves behind them. Many researchers believe stem cells could be grown into tissue to close the gap in the damaged nerves.

DR. BARTH GREEN, NEUROSURGEON: Stem cells not only can replace damaged cells, but they can help repair. COHEN: There's been some progress with animals. These rats were given a severe spinal cord injury and then injected with stem cells. Six weeks later, their hind legs were functioning again.

DR. JOHN GEARHART, JOHNS HOPKINS MEDICAL INST: We're well on our way in some of these areas, but we still have work to do.

COHEN: But there's a bitter ethical dispute about the use of embryonic stem cells, which many believe are the most promising for research. The embryos usually come from fertility clinics. They belong to parents who've decided not to use them to start a pregnancy. Using embryos for scientific research angers some groups.

JUDIE BROWN, AMERICAN LIFE LEAGUE: Human embryos who are people are being reduced to property and products and they are literally being marketed to the scientific community so that they're spare parts so-called can be used in research.

COHEN: Others say why not use the embryos for research that may be life saving? The other option, adult stem cells. They don't come from embryos. Instead they're derived from a variety of sources, such as bone marrow or the umbilical cords of newborn babies. But some scientists say they're not as easy to manipulate as embryonic cells.

Three years ago, President George W. Bush limited Federal funding of embryonic stem cell research to a specified group of existing stem cell lines. Researchers say this limited funding, coupled with possible contamination of the selected lines has slowed progress in the U.S. while other countries have moved ahead with research. In an effort to speed the progress, states like California are taking matters into their own hands. They're devoting millions of taxpayer dollars to embryonic stem cell research. No one can predict what, if any dividend, will come from that research.

GUPTA: Scientists say it's a bigger accomplishment than man landing on the moon. We'll unravel the number one medical story of the past 25 years. That's next.

DR. FRANCIS COLLINS, NATL INSTITUTES OF HEALTH: This will have turn out to have been one of the most major accomplishments with one of the most significant results that human kind has done up until now.

(COMMERCIAL BREAK)

GUPTA: That thing that makes each one of us different can also make us healthy or sick. By unlocking the story of us and or DNA, we may one day be able to cure disease and conditions at a genetic level. The number one medical story of the past 25 years could end up being the number one story of the next 25 years.

DR. CRAIG VENTER, J. CRAIG VENTER INSTITUTE: It will have a major impact on every major disease.

COLLINS: It will transform medicine in the course of the next 10 or 20 years. GUPTA: It is the mapping of the human genome and it's already having an impact, leading to the development of designer drugs, drugs that treat a specific disease or condition by targeting the faulty gene.

66-year-old John Rowe remembers when he was diagnosed with a very deadly form of cancer. Doctors told him it was a death sentence.

JOHN ROWE, CANCER PATIENT: Patients over 50 who develop CML face a 100 percent fatality rate.

GUPTA: But in 2001, a gene targeting medicine called Gleveck (ph) was approved for CML, chronic myeloid leukemia. After showing success where traditional cancer therapies had failed, Rowe began taking Gleveck as part of a clinical trial.

ROWE: It's causing a lot of excitement and I wanted it.

GUPTA: All because scientists were able to read our genetic code. The two men at the heart of the excitement, Francis Collins at the National Institutes of Health, leading a government quest involving scientists from all around the world. Craig Venter of the pharmaceutical development company Celera leading the private effort. Those scientists spent years racing towards the same goal, mapping the very stuff that makes each of us unique, our DNA.

BILL CLINTON, FMR PRESIDENT OF THE UNITED STATES: We're here to celebrate the completion of the first survey of the entire human genome.

GUPTA: Together, they made it, years ahead of schedule.

COLLINS: Putting a man on the moon, fabulous achievement to be sure. Figuring out the order of things in the universe in terms of the big bang, a fabulous accomplishment to be sure. But in terms of how it will affect our daily lives, the human genome product dwarfs those.

VENTER: Scientists around the world have all these new tools that have moved science forward by decades.

GUPTA: The genome holds information detailing every aspect of our existence. It's nature's blueprint of a human being and each person has a gene sequence. It's an order or recipe that is unique to them.

It starts with your DNA. Made up of thousands of genes which contain your genetic information. This individual genetic book inside each of us determines the color of our eyes, our hair and our skin. Those same genes also determine whether or cells will function normally or not, whether we're more prone to getting sick.

The benefits of this book of life will be seen for generations to come. Researchers expect to develop more effective diagnostic tools, determine individual risk for illnesses, understand how disease comes about and create more personalized medicines. VENTER: You'd certainly like to know if the drug's going to cure you or kill you and there's going to be clues in our genetic code of understanding those risks in advance.

COLLINS: By 2015, you will see the beginnings of a real transformation in the therapeutics of medicine, which by 2020 will have touched virtually every disorder.

GUPTA: In the future, there will be more genome success stories like John Rowe's.

ROWE: I'm in full remission, been in full remission 3 1/2 years now. No sign so far of the cancer coming back. Oh, it's the way to go. I say full steam ahead with this stuff.

GUPTA: And full steam ahead it is. Other new cancer drugs have been approved. One eresa (ph), has shown dramatic results in some lung cancer patients. So what else can we expect? Scientists guess that within 10 years, your genome can be sequenced in its entirely and will be part of your medical records for about $1,000 or less.

COLLINS: On to the future as fast as we can. There are people out there right now suffering from illnesses that we ought to be able to figure out.

GUPTA: From the human genome to the future of medicine, CNN will be there to bring you the latest and greatest of the next 25 years. Well, that's it for this edition of Top 25. Please visit our website at cnn.com/cnn25 to read more about the medical stories of the past 25 years.

Also be sure to join us next month as we countdown the top business leaders of the past 25 years. I'm Dr. Sanjay Gupta from Emory Crawford Long Hospital in Atlanta. Thanks for joining us.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com


Aired February 13, 2005 - 20:00   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
RANDI KAYE, HEADLINE NEWS, CNN CENTER ATLANTA: Hello, I'm Randi Kaye. CNN 25 is next. First, here's what's happening now.
Police in Ulster, New York are holding a suspect after a shooting in a crowded shopping mall. Two people are injured, one of them shot. This is a live picture outside the mall. The gunfire sent shoppers fleeing for safety.

Police say mall staffers overpowered the gunman when he ran out of bullets.

(BEGIN VIDEO CLIP)

CHIEF PAUL WATZKA, ULSTER, N.Y. POLICE DEPT.: The subject entered the Best Buy, started firing while walking through Best Buy. When he exited Best Buy into the corridor, that's when he was apprehended by a couple of the employees at the mall.

(END VIDEO CLIP)

KAYE: Tonight at 10:00 Eastern, the United Iraqi Alliance has won a plurality of the vote in Iraq's elections. That's good news for former Bush White House ally, Ahmed Chalabi. He ran with the majority Shiite Party. We'll get his take at 10:00 Eastern on CNN SUNDAY NIGHT.

More headlines in 20 minutes. Next, the top medical stories from 25 years of CNN.

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Twenty-five years and 25 stories that changed our world and our health.

It was once called a gay disease, but before we knew it, it belonged to all of us, everywhere, the epidemic in our backyard.

Then, years of lies about lighting up. How the little people made big tobacco pay.

Plus the mad cow that roared and made us look at our burger a bit differently.

And finally, changing what you don't like about yourself with a nip and a tuck, and a big ole price tag.

We're counting down the stories that made us healthy, wealthy and wise. Welcome to CNN's TOP 25. I'm Dr. Sanjay Gupta at Emory Crawford Long Hospital in Atlanta. This month our focus is the top medical stories of CNN's first 25 years.

People are living longer and healthier lives, thanks in part to the medical advances that we watched unfold right here on CNN.

Twenty-five years ago, no one had heard of HIV AIDS. Cloning was science fiction. And low carb was low profile.

We asked a panel of doctors to look at the major medical events CNN has covered over the years and come up with a list of the stories that shaped our health and changed our lives - for better or for worse.

DR. RANDY MARTIN, EMORY SCHOOL OF MEDICINE: We thought about things that have really advanced the science of medicine, advanced the caring of medicine and really have made an impact on people's lives.

GUPTA: Now that you know the prescription for the program, let's get it started, with an accidental discovery that impacted the sex lives of men and women around the world and became a punch line for late night TV. Here's No. 25.

A little blue pill starts off our list at No. 25. A little blue pill known as Viagra. Approved by the FDA in 1998, Viagra was brought to the market by Pfizer to treat erectile dysfunction, or ED. Yet that wasn't the original goal of Viagra.

Pfizer scientists were researching ways to treat heart conditions, and during trials noticed the unforeseen benefits for men suffering from ED. So the company turned the focus of the drug away from heart ailments, and Viagra was born.

At No. 24, Tylenol tampering, 1982. The nation was panicked after someone, who was never caught, injected cyanided into Tylenol capsules, killing seven. The company responded within days, recalling 31 million bottles in an unprecedented move. And it led to tamper- resistant consumer product packaging for many over-the-counter drugs, and a more prevalent use of caplets.

Hyperactivity, impulsiveness and a lack of attention span in children doesn't seem out of the ordinary, right? Yet for those kids who don't grow out of it, the four letters of the No. 23 selection on our list might be the answer - ADHD.

DR. WILLIAM T. BRANCH, EMORY SCHOOL OF MEDICINE: ADHD is Attention Deficit Hyperactivity Disorder, a disorder of children whereby they tend to be hyperactive. And also, they have difficulty in paying attention, organization, a kind of inability to complete a project - and difficulty in learning for those reasons.

GUPTA: ADHD was formally recognized in 1987 by the American Psychological Association as a medical diagnosis. Estimates from the National Institutes of Mental Health put between three and five percent of kids as having ADHD. As to what causes ADHD, that's still being studied, with the focus less on the effects of parenting, and more on the biological triggers in the brain.

It's been nearly 20 years since the world first heard the term mad cow disease. Since then, it's been a crisis that has crossed borders and claimed lives. And even though the number of known cases has plummeted, there are still many unanswered questions when it comes to mad cow.

Rick Sanchez explains.

(BEGIN VIDEO CLIP)

RICK SANCHEZ, CNN NEWS ANCHOR: The image of a staggering cow is one few people can forget. And not just for the graphic nature, but for the worldwide impact it would have on human health. Bovine spongiform encephalopathy first reared its ugly head in Britain, November 1986.

The degenerative disease attacks the cow's nervous system, causing changes in temperament, loss of coordination and eventually death. The U.K.'s epidemic led to the slaughter of more than three million cattle.

DR. LINDA DETWILER, FORMER OFFICIAL, U.S. DEPARTMENT OF AGRICULTURE: People didn't realize the implication that it would have.

SANCHEZ: At first it was an obscure medical term that most people wouldn't even be able to pronounce. But then, when people contracted the disease from eating tainted beef, the term mad cow would become a global, household word.

In 1996, British scientists announced the discovery of variant Creutzfeldt-Jakob disease - the human form of mad cow. The brain- wasting disorder has claimed nearly 160 lives across the globe, more than 90 percent of those occurring in the United Kingdom.

But perhaps most disturbing is the list of unknowns that still exist for this incurable disease.

GEORGE GRAY, EXECUTIVE DIRECTOR, HARVARD CENTER FOR RISK ANALYSIS: There's evidence right now that blood transfusions may be able to spread the variant form of CJD - vCJD, the human form of mad cow disease - from person to person.

SANCHEZ: Scarier still is this. This disease can lie dormant in your system for as long as 30 to 40 years.

DR. ERMIAS BELAY, MEDICAL EPIDEMIOLOGIST, CENTERS FOR DISEASE CONTROL AND PREVENTION, ATLANTA: Now because of, as you say, the long incubation period, it's possible that there are patients who are infected and are carrying the agent without showing the signs and symptoms. SANCHEZ: The United States had its own brush with mad cow when an infected cow turned up on U.S. soil in 2003. Turns out, the cow actually was from Canada, where two more infected animals have been uncovered, leading some researchers to believe there is still work to be done.

DETWILER: I think it's critical that both Canada and the United States maintain this high level of surveillance, so that we understand exactly how much disease is out there.

SANCHEZ: However, most experts say, the risk to American citizens is minimal at best.

DR. GARY WEBER, EXECUTIVE DIRECTOR, REGULATORY AFFAIRS, NATIONAL CATTLEMEN'S BEEF ASSOCIATION: I think BSE is going to go down in the next 25 years as a disease that once existed.

(END VIDEO CLIP)

GUPTA: In 20/20 hindsight, the No. 21 item on our list couldn't be clearer. Laser eye surgery burned onto the scene in 1988, when the first successful surgery to correct a patient's vision was performed.

MARTIN: For those individuals that are severely nearsighted - the ones who have been called wearing Coke-bottle-bottom glasses - this was a dramatic advance, because it really changed lives.

It made it so that people could see things in the dark, so that they could have proper employment - and you think of firefighters and people like that.

The ability to correct severe nearsightedness - and that's really what LASIK eye surgery was all about - was really a dramatic advance.

GUPTA: Burning big tobacco. Smoking? Still to come, how smokers turned the tables on companies who had torched the truth for decades. And ...

UNIDENTIFIED MALE: We're going to be paying the costs of the complications of this disease, well into the next three or four decades.

GUPTA: Step on the scale to see what's weighing heavily on our world, as we continue CNN's TOP 25.

(COMMERCIAL BREAK)

GUPTA: Many U.S. couples who had been unable to have babies got an assist in 1981 from No. 20 on our list - ART, or assisted reproductive technology.

MARTIN: In vitro fertilization is really an interesting concept. It really involves taking an egg from a woman and the sperm from a man, mixing them in a dish, getting an embryo - and then putting that back inside the woman to produce a baby. The option to use in vitro fertilization opened up the opportunity for a lot of people and a lot of couples who want to have babies.

GUPTA: From the delivery room to the courtroom for No. 19. Silicone implants from Dow Corning were commonly used in plastic surgery for women undergoing breast augmentation during the early '80s. But due to adverse effects of leaking implants, the company was forced to pay a multi-billion-dollar settlement brought by nearly 170,000 women.

BRANCH: The Dow settlement definitely changed the use of implants for breast augmentation. Basically, silicone was taken off the market, and it was replaced by saline implants.

GUPTA: The deadly dangers of cigarettes are nothing new. Still, more than a fifth of all Americans smoke. And smoking related illnesses cost the U.S. health care system as much as $75 billion a year.

Ali Velshi takes a look at the death and dollar signs that inspired No. 18.

(BEGIN VIDEO CLIP)

ALI VELSHI, CNN BUSINESS CORRESPONDENT: It was the mid-'90s. Cash-strapped states wanted to recoup the massive health care costs linked to smoking. The cigarette industry had money, but the states would have to prove that smoking was dangerous and addictive - charges that big tobacco had beaten back before.

I'm holding a copy of the 1890 edition of the U.S. Pharmecopeia, the most comprehensive listing of drugs in the United States. Well, you can see that tobacco appears here, but it didn't appear in the 1900 edition.

Well, a few years after that, the first law to regulate drugs in the United States was passed using the Pharmacopeia of the time as a guide to what was and wasn't a drug. Tobacco got a free pass.

A hundred years later, tobacco is still not considered a drug. But the Food and Drug Administration has argued that it should regulate tobacco products.

Former chief David Kessler recalls the warning from his advisors.

DR. DAVID KESSLER, FORMER COMMISSIONER, U.S. FOOD AND DRUG ADMINISTRATION: It's political suicide. It's a fools errand. It's the big muddy. Yes, it's the right thing to do, but the industry is too powerful.

VELSHI: The Supreme Court ruled against the FDA. But in 1998, big tobacco settled the states' case against it for nearly $250 billion. A pack of smokes went up 45 cents to pay that bill.

But where did the settlement money go? The states have only directed about a third of it to smoking-related health care. Only about five percent of the payout has gone to smoking prevention.

Tobacco giant Philip Morris admitted in 1999, that smoking is dangerous, and it's increased its spending on anti-smoking initiatives.

PEGGY ROBERTS, PHILIP MORRIS USA SPOKESWOMAN: We've paid the states over $18 billion. And we spent - we've spent well in excess of half a billion on youth smoking prevention.

VELSHI: But promotional spending in the cigarette industry overall is up - way up - from $6 billion a year in 1998 to $12 billion a year now.

How much would you say, as a percentage, do you spend on the youth smoking, anti-smoking initiatives versus promotions?

ROBERTS: I don't know the answer to that.

VELSHI: You sure?

ROBERTS: I really don't know that answer to that.

VELSHI: I bet it's a lot less.

ROBERTS: Probably, yes.

VELSHI: The U.S. Surgeon General now says smoking causes disease in nearly every organ of the body. And second-hand smoke? Nearly 800 municipalities have now banned or restricted public smoking.

In some 300 cities and towns across America, you can't even light up in a bar or a restaurant.

Today, fewer Americans do smoke and fewer teenagers are picking up the habit. Back in 1998, 3,000 teenagers started smoking every single day. Today only 2,000 will pick up the habit - only 2,000.

KESSLER: If we can get a young person to 18, 19 or 20, and they have not begun to smoke, it is unlikely that they ever will begin.

GUPTA: Potential side effects of No. 17 on our list, include increased knowledge of previously obscure medical conditions and the colorful drugs that treat them.

Direct-to-consumer marketing of prescription drugs began in 1997, as the FDA relaxed regulations as to how pharmaceutical companies could approach consumers.

BRANCH: My own opinion on direct-to-consumer marketing of brand name drugs is that it has been both good and bad. It has the potential to educate the public.

GUPTA: But Branch says some advertising goes too far and becomes misleading.

BRANCH: The extent that it misleads the public in some way, it is a danger. And I certainly they need - the FDA needs to continue to regulate these ads.

GUPTA: Coming in at No. 16, the 1999 outbreak of West Nile virus, the first ever in the United States.

DR. JULIE GERBERDING, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION, ATLANTA: At the very beginning of West Nile, it started in Manhattan the first year. And then it moved down the eastern seaboard the next year.

GUPTA: Evidence of West Nile has now been found in every U.S. state except Alaska and Hawaii, according to the federal government.

In the wake of September 11th, it was the terror that could show up in our mailbox.

LEROY RICHMOND, ANTHRAX SURVIVOR: I've never in my life been this sick before.

GUPTA: A quiet killer that could be mistaken for the flu.

And it's not who you are, it's how you look. Get a new nose, a new chin, a new grin - but keep your eyes on CNN's TOP 25. Stay tuned.

(COMMERCIAL BREAK)

GUPTA: Ninety-nine billion letters are sent through the U.S. Postal Service every year. And every day, Americans bring letters like these into their homes and tear them open.

But what if those envelopes contained a powder that could kill you?

(BEGIN VIDEO CLIP)

TOMMY THOMPSON, FORMER SECRETARY OF HEALTH AND HUMAN SERVICES: The Centers for Disease Control has just confirmed the diagnosis of anthrax.

JEANNE MESERVE, CNN NEWS CORRESPONDENT: It as a shocker and a killer. When all was said and done, five were dead, 22 became ill. One of them was postal worker Leroy Richmond.

LEROY RICHMOND, ANTHRAX SURVIVOR: My breathing became shallow. There was constriction in my chest. I had this pounding headache.

MESERVE: The method of attack could not have been more mundane - everyday envelopes addressed to members of Congress and media outlets.

The anthrax shut down Capitol Hill, caused partial paralysis of the male system, terrified the nation. And more than three years later, we still don't know who sent it.

REP. CHRIS SHAYS, (R) CONNECTICUT: Our best chance of catching this individual is when they do it again. And that's the last thing we want to happen. MESERVE: The anthrax attack shut down this postal facility in Washington, D.C. for two years. What if it did happen again? Would the nation be better prepared?

THOMAS DAY, VICE PRESIDENT OF ENGINEERING, U.S. POSTAL SERVICE: If anything were escaping, it's going to be drawn into the filter.

MESERVE: At processing centers, the Postal Service has installed ventilation systems intended to capture any substance escaping from a letter, and biological detection systems to identify anthrax.

DAY: It's reliable, and it's very sensitive.

MESERVE: But in the health arena, bioterrorism experts say, there is much more to be done.

DR. THOMAS INGLESBY, CHIEF OPERATIONS OFFICER, CENTER FOR BIOSECURITY, UNIVERSITY OF PITTSBURGH MEDICAL CENTER: Three-and-a- half years later, we still don't have any rapid diagnostic test, to be able to distinguish an anthrax-infected patient from somebody who has the flu.

MESERVE: Once it is diagnosed, physicians have learned rapid treatment with antibiotics can have a huge impact.

RON BROOKMEYER, JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH: If we could get antibiotics to people within six days, we could prevent 70 percent of cases.

MESERVE: The nation has stockpiled enough antibiotics to treat two major metropolitan areas, but a drug-resistant strain of the bacteria could make them useless.

A next-generation vaccine is in production. The government expect to take delivery of 75 million doses by November of 2007. And further innovations may be ahead.

INGLESBY: It's imaginable that people could have in reserve patches that contain anthrax vaccine. In the event of a crisis in America, people simply get out the patch and slap it on their arms.

MESERVE: The most significant after-effect of the anthrax attacks, experts say, may be that physicians are better trained to recognize anthrax - if this ever happens again.

(END VIDEO CLIP)

GUPTA: Cystic fibrosis, muscular dystrophy, sickle-cell anemia - all hereditary conditions for which traditional medicine has provided no cure.

But some see potential in No. 14 on our list - gene therapy.

BRANCH: Gene therapy in humans is asserting a gene into a diseased organ or tissue, and thereby correcting the disease by inserting a healthy gene. GUPTA: The first authorized gene therapy was successful in 1990, treating two Ohio girls suffering from the lack of an immune system, who remain healthy today. Yet the death of a teenager in the late 1990s during a trial prompted a slowdown, as researchers continue to test the most effective ways to apply the therapy.

If you weren't born with a perfect face or body, lucky No. 13 can help you change all that. As Elizabeth Cohen reports, millions of Americans are willing to undergo the knife to change the way they look - and feel.

(BEGIN VIDEO CLIP)

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: In a world of extreme makeovers and swong (ph) ...

UNIDENTIFIED MALE: A team of plastic surgeons will turn these 16 average women into drop-dead beauties.

COHEN: Plastic surgery experts say these reality shows - telling people they can change anything they don't like about their appearance - are fueling a boom in cosmetic surgery.

More cosmetic procedures are performed in the U.S. than in any other country, according to the International Society of Aesthetic Plastic Surgery. In 2003, that number topped 8.3 million. That's a 20 percent increase from 2002, and a 293 percent increase in the total number of cosmetic procedures since 1997.

DR. MILES GRAIVIER, PLASTIC SURGEON: And I think with the reality shows on plastic surgery, the numbers are going to be exponentially higher.

COHEN: But before these shows made their way into prime time, it all started with images like this - and this. Breast augmentation, liposuction and tummy tucks to suck the fat, face lifts, nose reshaping and eyelid surgery are the most popular surgical procedures.

People are also opting to make their hands look younger and their feet more comfortable in their high-fashion shoes. And it seems like everyone is doing it.

LYNNE LUCIANO, SOCIAL HISTORIAN: Everybody is getting on the band wagon - all ages, all income levels, all ethnicities.

COHEN: While women represent the majority, the number of men is on the rise.

GRAIVIER: It's not a stigma any more to go in - even for a man - to have some type of cosmetic surgery procedure.

COHEN: Mexico and Brazil come in second and third for the number of procedures they perform, and some Americans even travel there to get a vacation while they recover from their nip and tuck.

In China, there are more than one million cosmetic surgery clinics. The country even hosts a Miss Plastic Surgery pageant. The only requirement for the participants is that they've gone under the knife.

Safety issues plagued the industry in the 1990s. Fear over leaking breast implants led to a ban on silicone. Saline's an alternative. And newer materials - such as cohesive gel, which some say are safer - are under consideration by the U.S. Food and Drug Administration. They could get approval later this year.

There were even deaths from liposuction, blamed on the removal of too much fat and centers ill-equipped to handle what went wrong during surgery.

But with new technology and some safer procedures, that's all changing. Less invasive surgeries are an option, promising a shorter recovery, getting patients home and even back to work within days.

DR. BRIAN KINNEY, PLASTIC SURGEON: The emphasis is on minor procedures, smaller procedures, quicker return to work.

COHEN: And there's a move toward simplicity. Over six million non-surgical cosmetic procedures were performed in 2003.

Plastic surgeons say patients are now opting for classical features.

KINNEY: People coming in and say, I don't want to be extreme, and I don't want to be made over. I want to be subtle, I want to be natural.

COHEN: Perhaps cosmetic procedures are creating a new natural.

(END VIDEO CLIP)

GUPTA: The low carb craze is next on our countdown at No. 12. Whether the supermarket or eating out, low carb options are everywhere.

The low carb lifestyle became all the rage with the emergence of the Atkins Diet in the '80s. The Zone, Sugar Busters and the South Beach diets continued the carb-cutting trend.

MARTIN: I think people would say that it is a fad. What we're realizing - and what we've known for quite a while - is that you have to have the right kind of carbohydrates, the right kind of fats. You have to watch calories. You have to watch portion size.

GUPTA: At No. 11 is phen-fen, the so-called magic weight loss pill.

Phen-fen is a combination of two drugs - fenfluramine, an appetite suppressant, and phentermine, a mild stimulant. Combined, they create a powerful diet drug.

But the popular combo disappeared from the marketplace after the FDA asked the manufacturer to withdraw one of the drugs in the combination.

MARTIN: The FDA actually began an investigation, and said that we should really not use these medicines as weight loss. And so, it really goes back to the old thing, you've got to have lifestyle changes.

GUPTA: Twenty-five years ago, no one had heard of it.

UNIDENTIFIED MALE: I didn't really anticipate that we would have one of the most devastating, if not the most devastating, global pandemic in history.

GUPTA: Now, millions around the world live with it, and fight against it. Coming up.

And tipping the scales on another kind of epidemic. But this one has a cure. Stay tuned to CNN's TOP 25.

(COMMERCIAL BREAK)

KAYE: Hello. I'm Randi Kaye, CNN 25 continues in a moment. First the latest headlines. A group made up of Iraq's majority Shiites has more votes than any other party in the national election but results announced today show it falling short of an outright majority. Out of some 8 million voters, the United Iraqi Alliance tops at about 47 percent. The Kurdish coalition won about 25 percent and the Iraqi National Accord is at 13.6 percent.

Police say they believe a 24-year-old man was acting alone in a shooting spree inside a shopping mall in Ulster, New York. The suspect is in custody. Officers say mall employees jumped him when he ran out of ammunition. Two people were injured, one by the gunfire.

On a happier note, Valentine's Day is tomorrow. Noted sex therapist Dr. Ruth Westheimer (ph) joins us with advice for the occasion at 10:00 Eastern on CNN SUNDAY NIGHT.

That's our latest. Next, more top medical stories from 25 years of CNN.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Welcome back to CNN's top 25. I'm Dr. Sanjay Gupta and we're counting down the top medical stories of the past quarter century. Hospitals like this one have changed to accommodate new diseases and health problems never even imagined just 25 years ago. Before the break, we were looking at body image and the quest to stay thin. But in staying with the theme, number 10 takes the bathroom scale one step further.

Do you know your BMI? Put down the fork and pick up the weights at number 10, knowing your BMI may be the key to better health.

DR. RANDY MARTIN, EMORY SCHOOL OF MEDICINE: BMI stands for the body mass index and why it came about is that it was a way to really tie your weight, height complex, the body mass index, to your potential risk for developing diseases, because the higher your BMI, the more likely you were to develop diabetes, osteoarthritis and even cancers.

GUPTA: So how do you calculate it?

MARTIN: If you take your weight in pound and divide it by your height in inches squared and multiply it by 703, then you'll get your BMI and BMI is an excellent way for most of us to judge where do you stand in an idea weight and are you at risk for developing diseases?

GUPTA: In a nation of super sized fries, there are now super sized people. One in three American adults is considered obese, with the BMI of 30 or more and with obesity becoming more prevalent, comes a whole new set of health problems. Holly Firfer tallies the issue of weight at number nine.

HOLLY FIRFER, CNN CORRESPONDENT: Big, bigger, deadly. This year, complications of obesity will kill an estimated 365,000 Americans. This is not just losing 10 pounds you gained over the holidays. We're talking about an obesity epidemic, 59 million people whose lives are at risk, according to the Centers for Disease Control and Prevention, because they need to lose weight.

DR. WILLIAM DIETZ, CENTERS FOR DISEASE CONTROL AND PREVENTION: Obesity is the epidemic of the century. Over 30 percent of adults in this country are obese, defined as a body mass index greater than or equal to 30. Our concern about this problem is that obesity is the major cause of heart disease, Type II diabetes and cancer.

FIRFER: It's not just a matter of too many adults visiting the fast food drive throughs. Since 1980 according to the government, obesity rates have doubled among children and tripled among adolescents. The problem, high fat, high calorie foods and physical inactivity, byproducts of a high tech, coach potato lifestyles.

Remember this guy? Morgan Spurlock (ph). He put a fast food giant to the test by eating nothing by McDonalds for a month. The result: he gained 25 pounds. He went from the picture of perfect health to a medical basket case but it was a box office hit.

Even though Americans are so obsessed with dieting that it's become a $40 billion a year industry, we are fatter than ever.

ADELE MILLER, WEIGHT WATCHERS MEMBER: Just sort of crept up on me. I gained what, maybe one or two pounds a year. Over time that turned into like 30 pounds and that was very, (INAUDIBLE) a lot of weight for me. I could feel it. I started snoring. I started having heartburn. I started having pains in my knees.

LORRAINE RUSSELL, WEIGHT WATCHERS MEMBER: My (INAUDIBLE) weight is, let's just say I have 112 pounds to lose to get there.

FIRFER: So what is an ideal target weight and who sets the standard? The government does. The National Institutes of Health defines overweight as an increased body weight in relation to height. Let me give you an example. I'm 5 foot 3 and about 118 pounds. If I gained just 18 pounds or something about the weight of a bowling ball, I would be overweight. Make that 51 pounds or about the weight of 2 1/2 bowling balls, I would be considered obese.

It's not just a problem in this country. According to estimates from the World Health Organization, 22 million of the world's children under the age of five are over weight. The number of over weight adults according to these estimates has reached one billion worldwide. Nearly one third are classified as obese.

DIETZ: If we don't successfully prevent obesity, we're going to be paying the costs of the complications of this disease well into the next three or four decades and those costs are going to be the costs of heart disease, diabetes and cancer, all of which are linked to obesity.

GUPTA: As the countdown continues, buckle yourself in at number eight with the seat belt use law that was enacted in 1984 in New York. Laws vary from state to state. About half require all adults and older children to wear belts and for infants to be restrained in child car seats.

DR. WILLIAM T. BRANCH, EMORY SCHOOL OF MEDICINE: The seat belt law was enacted because of the unequivocal evidence that seat belts save lives. There's a great deal of positive things that come out of the seat belt law. Lives are saved. The community saves its resources that would be spent on treating people who would be more seriously injured.

GUPTA: At number seven is the widely used antidepressant drug Prozac. Since its introduction in 1986, Prozac has been used by more than 40 million people worldwide, more than 10 million for depression, making it the most popular antidepressant ever.

BRANCH: I think it became popular because in fact you could give the drug and there were very few side effects in most people. Also it seems to have somewhat more rapid onset of action against depression and it gives people more energy so it has this kind of activating effect.

GUPTA: But there are concerns about the drug.

BRANCH: There has been publicity about Prozac and the question that's been raised about that class of drugs is in whether they contribute to suicide. This is a controversial topic.

GUPTA: At number six, it's a medical first, 2001 doctors at Jewish hospital in Louisville, Kentucky implant the first self- contained mechanical heart. 59-year-old Robert Tools (ph) received a battery-powered aviacor (ph) heart.

MARTIN: He lived 151 days which is really, was very dramatic.

GUPTA: The softball sized device is designed to fully sustain the body's circulatory system while allowing recipients to maintain a productive lifestyle. But there are still major advances needed.

MARTIN: So while there's tremendous development being done, I think what we'll see is very small devices now that will sort of take over the pumping action of the heart and rest it and the heart repaired itself and then you remove them. So I think most of us believe that a totally artificial heart is still some ways out.

(COMMERCIAL BREAK)

GUPTA: We're closing in on the top five, but before we move on, let's look back at numbers 10 through six. Landing at number 10, body mass index. It's not just about how much you weigh, but what makes up that weight that matters.

Number nine, a nation with an appetite for food. Obesity is changing the face of America and America's health. Buckle up at number eight. Seat belts saving lives. Did you even know your car had seat belts in 1980? Then number seven, medicating your depression away with Prozac and at number six, the first self-contained artificial heart transplant.

And that brings us to number five and a transplant of another kind. The first successful living liver transplant makes it to number five on the list. Medical history was made in 1989 when Terri Smith donated a portion of her liver to her 21-month old daughter Allysa.

TERRI SMITH, ALLYSA'S MOM: I realize that part of me is in her now. Part of my liver is functioning as her liver.

GUPTA: The University of Chicago had just established a program of living donor liver transplantation to reduce the shortage of appropriate donors for infant recipients.

DR. CHRISTOPHER BROELESCH, ALLYSA'S SURGEON: I think it's an attempt in the right direction and I think it's going to change the face of (INAUDIBLE) liver transplantation.

GUPTA: Today, the technology used by the University of Chicago team has since become a building block for transplants.

No transplant or procedure can reverse number four. AIDS has no cure and no end in sight. It's estimated 14,000 people a day become HIV positive. Let's take a closer look at treating a disease that is all too often a death sentence. Dr. Bruce Rashbaum has been on the front lines of HIV for about 20 years as both a doctor and a patient.

DR. BRUCE RASHBAUM, NATL INSTITUTES OF HEALTH: In 1997 I took 20 pills. Other patients certainly could have taken more than that. Some people probably took 30 pills.

GUPTA: That was every day. Now HIV treatment has been so well refined, he and many patients like him are down to about three or four pills a day. But the fact that people like Rashbaum who were infected in the early days are even alive is quite significant.

The year was 1981 and here in the U.S., the first cases of a yet unnamed mystery disease began appearing in gay men.

DR. ANTHONY FAUCI, NATL INSTITUTES OF HEALTH: I didn't really anticipate that we would have one of the most devastating, if not the most devastating global pandemic in history.

GUPTA: 1982, the term acquired immune deficiency syndrome or AIDS is first used and within a year, researchers had determined it was the HIV virus that was destroying the patient's immune system and killing them.

CLEVE JONES, FOUNDER, AIDS QUILT: Every time I went out of my apartment, I would see people dying, people my age walking around on canes with no hair.

GUPTA: Then in 1996, things changed. A class of drugs called protease inhibitors were approved by the FDA. Doctors began to combine them with other HIV medicine into an AIDS drug cocktail and HIV was no longer considered a death sentence.

FAUCI: Certainly it's not a cure, but it was a dramatic turnaround.

GUPTA: But the drugs are expensive, so costing as much as $10,000 a year, financially out of reach for many of the estimated 40 million people worldwide who now have HIV AIDS. Although every continent has been hit, the vast majority are in sub-Saharan Africa and given the cost, for most there, HIV is still a death sentence.

DR. PETER PIOT, UNAIDS: We don't (ph) expanding prevention and treatment efforts in the developing world over the next decades, tens of millions of people are going to die.

GUPTA: Some experts say a vaccine is the only hope for stopping the disease, but so far, efforts to develop the vaccine haven't panned out. There's a saying among vaccine researchers. Follow the body's response, meaning mimic in the lab what the body does naturally to get rid of disease. But the problem is, of the more than 16 million people who have been infected with HIV, there is no known case of a single person getting rid of the virus.

FAUCI: If you don't have anybody recovering completely from HIV, then you don't have any blueprint for the way you want to go with your vaccine.

GUPTA: Without a vaccine, the spread of HIV is best reduced by treating those who have the disease.

FAUCI: I think we will for a very long time have a world with HIV but I think a world in which the epidemic is going in the opposite direction is within our grasp.

GUPTA: At number three is the controversial topic of cloning.

SEN. BILL FRIST (R) TENNESSEE: The first successful cloning of an adult mammal has captivated the attention of the world.

GUPTA: At the center of all the attention is Dolly. Cloned by Dr. Ian Wilmut and his team at the Roslin Institute near Edinburgh, she was born on July 5th, 1996. DR. IAN WILMUT, CREATOR OF DOLLY, ROSLIN INSTITUTE: There are a number of genetic diseases for which there isn't a cure at the present time, serious diseases and this will enable us to carry out research into the causes of those diseases and perhaps develop methods to treat them.

GUPTA: Dolly was put down in February of 2003 due to complications from a progressive lung disease. But should this research be used to clone a human? The ethical and scientific debate continues to rage today.

BRANCH: Well, I think there's one extremely practical concern with cloning humans. We don't really know what the effects are when you clone the DNA of an adult.

GUPTA: Just recently, the British government gave the Roslin Institute a license for therapeutic cloning which creates, then destroys human embryos as a source for stem cells to be used to help cure diseases, a method that many have questioned.

WILMUT: We have to demonstrate that it was not possible to do this research in any other way and I believe that that is true.

UNIDENTIFIED MALE: Ultimately, cloning will be used in one form or another and hopefully with adequate controls over all of the potential ill effects that might result.

GUPTA: Ethics also meets science in number two, embryonic stem cell research. The potential of tiny cells with enormous possibilities have been lost in a political argument, but not forgotten. Here's Elizabeth Cohen to shed some light on the story.

ELIZABETH COHEN, CNN CORRESPONDENT: They're perhaps the most controversial frontier in modern medicine. Many scientists believe these tiny cells hold the potential to treat diseases such as diabetes, Alzheimer's and Parkinson's and even spinal cord injuries. Celebrity sufferers have beaten a drum for exploiting stem cells.

MICHAEL J. FOX: I'm one of the million involuntary experts on Parkinson's disease in the United States. That (INAUDIBLE) destructive nature as we wait for a cure.

CHRISTOPHER REEVE: It's a miracle. It's something that has unlimited potential for curing people.

COHEN: The search for a cure became the life work of actor Christopher Reeve before he died in 2004. Embryonic stem cells are unspecified or blank cells. Scientists hope they can manipulate these cells into becoming any type of cell. For example, with some spinal cord injuries, broken vertebrae cut the bundle of nerves behind them. Many researchers believe stem cells could be grown into tissue to close the gap in the damaged nerves.

DR. BARTH GREEN, NEUROSURGEON: Stem cells not only can replace damaged cells, but they can help repair. COHEN: There's been some progress with animals. These rats were given a severe spinal cord injury and then injected with stem cells. Six weeks later, their hind legs were functioning again.

DR. JOHN GEARHART, JOHNS HOPKINS MEDICAL INST: We're well on our way in some of these areas, but we still have work to do.

COHEN: But there's a bitter ethical dispute about the use of embryonic stem cells, which many believe are the most promising for research. The embryos usually come from fertility clinics. They belong to parents who've decided not to use them to start a pregnancy. Using embryos for scientific research angers some groups.

JUDIE BROWN, AMERICAN LIFE LEAGUE: Human embryos who are people are being reduced to property and products and they are literally being marketed to the scientific community so that they're spare parts so-called can be used in research.

COHEN: Others say why not use the embryos for research that may be life saving? The other option, adult stem cells. They don't come from embryos. Instead they're derived from a variety of sources, such as bone marrow or the umbilical cords of newborn babies. But some scientists say they're not as easy to manipulate as embryonic cells.

Three years ago, President George W. Bush limited Federal funding of embryonic stem cell research to a specified group of existing stem cell lines. Researchers say this limited funding, coupled with possible contamination of the selected lines has slowed progress in the U.S. while other countries have moved ahead with research. In an effort to speed the progress, states like California are taking matters into their own hands. They're devoting millions of taxpayer dollars to embryonic stem cell research. No one can predict what, if any dividend, will come from that research.

GUPTA: Scientists say it's a bigger accomplishment than man landing on the moon. We'll unravel the number one medical story of the past 25 years. That's next.

DR. FRANCIS COLLINS, NATL INSTITUTES OF HEALTH: This will have turn out to have been one of the most major accomplishments with one of the most significant results that human kind has done up until now.

(COMMERCIAL BREAK)

GUPTA: That thing that makes each one of us different can also make us healthy or sick. By unlocking the story of us and or DNA, we may one day be able to cure disease and conditions at a genetic level. The number one medical story of the past 25 years could end up being the number one story of the next 25 years.

DR. CRAIG VENTER, J. CRAIG VENTER INSTITUTE: It will have a major impact on every major disease.

COLLINS: It will transform medicine in the course of the next 10 or 20 years. GUPTA: It is the mapping of the human genome and it's already having an impact, leading to the development of designer drugs, drugs that treat a specific disease or condition by targeting the faulty gene.

66-year-old John Rowe remembers when he was diagnosed with a very deadly form of cancer. Doctors told him it was a death sentence.

JOHN ROWE, CANCER PATIENT: Patients over 50 who develop CML face a 100 percent fatality rate.

GUPTA: But in 2001, a gene targeting medicine called Gleveck (ph) was approved for CML, chronic myeloid leukemia. After showing success where traditional cancer therapies had failed, Rowe began taking Gleveck as part of a clinical trial.

ROWE: It's causing a lot of excitement and I wanted it.

GUPTA: All because scientists were able to read our genetic code. The two men at the heart of the excitement, Francis Collins at the National Institutes of Health, leading a government quest involving scientists from all around the world. Craig Venter of the pharmaceutical development company Celera leading the private effort. Those scientists spent years racing towards the same goal, mapping the very stuff that makes each of us unique, our DNA.

BILL CLINTON, FMR PRESIDENT OF THE UNITED STATES: We're here to celebrate the completion of the first survey of the entire human genome.

GUPTA: Together, they made it, years ahead of schedule.

COLLINS: Putting a man on the moon, fabulous achievement to be sure. Figuring out the order of things in the universe in terms of the big bang, a fabulous accomplishment to be sure. But in terms of how it will affect our daily lives, the human genome product dwarfs those.

VENTER: Scientists around the world have all these new tools that have moved science forward by decades.

GUPTA: The genome holds information detailing every aspect of our existence. It's nature's blueprint of a human being and each person has a gene sequence. It's an order or recipe that is unique to them.

It starts with your DNA. Made up of thousands of genes which contain your genetic information. This individual genetic book inside each of us determines the color of our eyes, our hair and our skin. Those same genes also determine whether or cells will function normally or not, whether we're more prone to getting sick.

The benefits of this book of life will be seen for generations to come. Researchers expect to develop more effective diagnostic tools, determine individual risk for illnesses, understand how disease comes about and create more personalized medicines. VENTER: You'd certainly like to know if the drug's going to cure you or kill you and there's going to be clues in our genetic code of understanding those risks in advance.

COLLINS: By 2015, you will see the beginnings of a real transformation in the therapeutics of medicine, which by 2020 will have touched virtually every disorder.

GUPTA: In the future, there will be more genome success stories like John Rowe's.

ROWE: I'm in full remission, been in full remission 3 1/2 years now. No sign so far of the cancer coming back. Oh, it's the way to go. I say full steam ahead with this stuff.

GUPTA: And full steam ahead it is. Other new cancer drugs have been approved. One eresa (ph), has shown dramatic results in some lung cancer patients. So what else can we expect? Scientists guess that within 10 years, your genome can be sequenced in its entirely and will be part of your medical records for about $1,000 or less.

COLLINS: On to the future as fast as we can. There are people out there right now suffering from illnesses that we ought to be able to figure out.

GUPTA: From the human genome to the future of medicine, CNN will be there to bring you the latest and greatest of the next 25 years. Well, that's it for this edition of Top 25. Please visit our website at cnn.com/cnn25 to read more about the medical stories of the past 25 years.

Also be sure to join us next month as we countdown the top business leaders of the past 25 years. I'm Dr. Sanjay Gupta from Emory Crawford Long Hospital in Atlanta. Thanks for joining us.

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