Small Victories on Many Battlefronts : Medicine: Political wrestling over health-care reform may hog the headlines, but the year should also bring breakthroughs on several drugs and diseases.

There will be more to the year in health and medicine than the fierce fighting expected over health-care reform.

New medications, an improved understanding of certain mental disorders and a dramatic improvement in in vitro fertilization are just a few events to watch for in 1994.

Here’s a look at the coming year in health:

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Updating Mental Health: A revised and updated version of the “bible” of mental health--the “Diagnostic and Statistical Manual”--will be published in May.

The thick manual, which will be available in most bookstores, lists every recognized diagnosis in psychiatry as well as information on moods and behavior. The last revision, called DSM-III R (for revised), was published in 1987, and work on updating the book began almost immediately. Because of rapid advances in mental health research, the DSM-IV will contain some dramatic changes.

One big change is the elimination of the term “organic” from diagnoses. This reflects the now well-accepted belief that most mental illnesses have some biological basis that cannot be separated from psychological causes, said Dr. Allen Frances, DSM-IV task force chairman.

A controversial decision is that Premenstrual Dysphoric Disorder was retained as a “possible” disorder that “requires further study” instead of being elevated to the status of a separate, specific diagnosis or eliminated altogether. Premenstrual Dysphoric Disorder is defined in the book as a severe depressive condition that differs greatly from premenstrual syndrome--or PMS--which is considered a mild set of physical and emotional symptoms and not a mental disorder.

Women’s groups have criticized the inclusion of Premenstrual Dysphoric Disorder because they say there is no solid research linking women’s hormone cycles to bad moods.

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At the Pharmacy: You may see changes in the way drugs are packaged.

The traditional American packaging--a bottle with a childproof safety cap--may give way in some cases to blister packaging. Blister packaging uses plastic or foil to house each pill in its own little bubble, the way birth control pills are usually packaged.

The goal is to cut down on incorrect doses.

More than half of the 1.8 billion prescriptions dispensed annually are taken incorrectly, resulting in about 125,000 deaths per year, according to the Healthcare Compliance Packaging Council. The group was formed a few years ago to deal with this issue. It says increased use of blister packaging, which can be clearly and simply marked, greatly reduces noncompliance. In Europe, more than 80% of drugs are blister packaged compared with 20% in this country.

Also on the pharmaceutical front:

* Many top-selling brands will go off patent, opening the way for generic competition and lower prices. Commonly prescribed drugs that will lose their patents in 1994 include Cardizem CD, Seldane, Tagamet, Wellbutrin and Anafranil.

* Varivax, the long-awaited chicken pox vaccine, is expected to win Food and Drug Administration approval this year.

* Tagamet, for heartburn and ulcers, may move from prescription to over-the-counter status.

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In Vitro Fertilization: Couples who have long since given up on having a baby because of fertility problems may be inspired to try again based on a dramatic advance in in vitro fertilization. The advance addresses male infertility caused by very low sperm count or poor quality sperm.

The technique was created in Belgium, and American researchers are flocking there to learn the method. Called single-sperm IVF, or intracytoplasmic sperm injection, the technique “could spawn an entire industry of IVF laboratories for couples who have been told that the male partner is hopelessly infertile,” according to a recent report in Medical World News.

The method involves the injection of a single sperm into an egg and has resulted in 300 pregnancies and 100 births worldwide. Eggs are fertilized in 65% of the cases and one-third of the women who receive embryos actually become pregnant, according to the American Fertility Society in Birmingham, Ala.

The method is dramatic because only one sperm, no matter what its shape or speed, is needed. In conventional IVF, 50,000 to 5 million sperm are needed. In a newer technique called partial zona dissection, in which the egg shell, or zona, is pierced first, 5,000 to 10,000 mobile sperm are needed.

Infertility affects about 2 million U.S. men. About one-third have sperm deficiencies so severe that no IVF methods have worked.

“Sperm injection may be the biggest breakthrough in the treatment of male infertility since the invention of in vitro fertilization itself,” said Dr. Joseph Schulman, director of the Genetics and IVF Institute in Fairfax, Va.

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Safer and Better Sex: Condoms make the difference between safe and unsafe sex, yet public health experts say too few people use them. One reason is because people dislike how they feel.

That’s why health officials are enthused about the possible marketing this year of a new polyurethane condom.

Polyurethane is a very soft, stretchy and flexible plastic, but it is twice as strong as latex, the material now used in most condoms.

“Because it is twice as strong as latex, you have an opportunity to make it thinner and yet have the same strength,” said Ron Freziersc, director of research for the Los Angeles Regional Family Planning Council, which is studying the product.

Because it is thinner, this condom may improve sensitivity. It will also have a baggier, less constrictive fit. The condom will also be useful to people who are allergic to latex.

The four-year study, funded by the National Institutes of Health, will examine whether the product is as effective as touted. But, Freziersc said, “It looks like it’s going to be the next exciting condom.”

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Know Your Risk of Colon Cancer: One of the first widely used tests to predict who might carry a gene for a particular disease may become available this year.

Last month, researchers announced they had found the defective gene that causes the majority of inherited colon cancers. The gene is carried by one of every 200 people, so screening families with a history of the disease could identify those who carry the gene and might develop the disease. Colon cancer is highly curable if detected early. Researchers predict that the first versions of the test will cost about $1,000.

“It seems likely that this will be the first (genetic) test that will find its way into general clinical practice, and it will usher in a new era of genetic medicine,” said Dr. Francis Collins, director of the National Center for Human Genome Research.

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Healthy Behavior Pays Off: More insurance companies likely will reimburse clients for treatment of heart disease that is based on non-drug treatments, such as a combination of diet, exercise and meditation made popular by Dr. Dean Ornish, director of the Preventive Medicine Research Institute in Sausalito.

Last October, Mutual of Omaha became the first insurer to reimburse heart-disease patients who participate in Ornish’s therapy.

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Disney Technology Comes to Medicine: Holograms, which provide the first true three-dimensional images of the anatomy, may gain wider use in medicine.

The technology allows doctors to see deep within the body--without surgery. The pictures are created with a new type of holographic camera from the digital data gathered by CT or MRI scans. Those procedures give only two-dimensional views of the body.

Holograms have already been used to study the blood flow in the heart and neck and to examine bone cancers, according to researchers speaking at the annual Radiological Society of North America meeting last November. The medical applications of holography were developed by VOXEL of Laguna Hills.

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AIDS Research: This year will mark a surge in research emphasizing repairing the damaged immune system of AIDS patients, a recent report in the Journal of the American Medical Assn. predicts.

In recent years, research has centered on stopping the virus from replicating in the body. Scientists now believe that both approaches are important but say that immune research has languished. Project Immune Restoration, a think tank composed of researchers, government officials and AIDS activists, has been formed to accelerate work on the strategy.

Many immune cell-therapy trials will get under way this year. In general, the idea is to take immune cells from patients while they are healthy, boost or augment them in a laboratory culture and reinfuse them in the later stages of the disease.

“This field is moving fast,” says Dr. Robert Schooley, chief of infectious diseases at the University of Colorado School of Medicine.

An AIDS vaccine is still perhaps five years from the market. But, in one sign of progress, large-scale human trials to gauge efficacy of vaccines in development should begin this year.

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Gum Ratings: In dentistry, the trend is to know your gum health--much the way people memorize their cholesterol levels.

It is becoming routine for dentists to measure the space between the tooth and gum in order to check for gum disease. There are six possible readings, and large spaces indicate possible gum disease, says Marina del Rey dentist Christine Dumas, a spokeswoman for the California Dental Assn.

“You can actually measure the level and extent of gum disease. Three out of four Americans have some form of gum disease but don’t know it. In most cases there is no pain and no discomfort until you have a large amount of bone loss,” Dumas said. “Know your numbers, and those numbers will determine what you’ll do at home and how often you go see the dentist.”