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There is little doubt that depression is bad for the heart. Much as fatty diets, cigarette smoking, inactivity and obesity are linked with an increased risk of heart disease, recent evidence suggests that mental health has a similarly powerful impact. The question has always been, why?

Now, researchers provide the first data that may explain the association. Published in the Journal of the American Medical Association, the findings suggest that depression contributes to heart disease indirectly — by fostering unhealthy behaviors like smoking — rather than directly. Certain biological factors linked with depression, such as inflammation and the levels of brain chemicals like serotonin, may play some role in heart health, researchers say, but the new study found that the factors that most increased heart disease risk in depressed people were the ones you might expect: lack of exercise and smoking.

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"We looked at all sorts of biological markers that could potentially play a role in linking depression and heart disease," says Dr. Mary Whooley, an internist at the VA Medical Center in San Francisco, and lead author of the new study. "We measured all of those, and found that they did not explain the association. All we needed to do was to ask the patient how much they were exercising to be able to explain the link."

Whooley studied more than 1,000 patients with heart disease at the VA for nearly five years. The patients filled out regular questionnaires to determine their mood state, and were asked yearly to report on any heart-related events. Researchers took blood and urine samples to measure their levels of omega-3 fatty acids, cortisol and the inflammatory marker C-reactive protein, as well as the neurotransmitters serotonin and norepinephrine — all agents that may be involved in both depression and heart disease. In all, about 20% of the participants reported depressive symptoms; over five years, those patients had a 50% higher rate of additional heart problems, compared with their non-depressed peers.

Whooley's team studied the depressed group further. Researchers systematically adjusted for each potential risk factor to figure out whether it was mediating the link between depression and heart disease. Physiological factors, such as serotonin levels or CRP, for example, appeared not to have much impact. But when researchers adjusted for physical activity — that is, when they analyzed the data by assuming identical levels of exercise in both depressed and non-depressed patients — the difference in heart disease risk between the groups disappeared. Indeed, inactivity among the depressed patients gave them a 44% greater risk of having a heart event than people who were not depressed, accounting for nearly all of the depressed patients' 50% higher risk. Picking up the remainder of the increased risk was cigarette smoking.

The findings suggest that the effect of depression on heart health may have less to do with changes in hormones or other biochemical pathways, and more to do with behavior. Compared with other people, notes Whooley, the depressed are less healthy overall — they're less likely to exercise or take their heart medications, and are more likely to smoke. The relationship also feeds back on itself; previous studies show that exercise not only improves cardiovascular health, but also elevates mood and can ease depression.

The study may even help to explain why treating depression alone — rather than addressing patients' mental state and accompanying behavioral changes — has not proven successful in reducing the risk of heart disease. "We have always looked at certain behaviors like physical activity and smoking in isolation with respect to their effect on heart disease," says Dr. Clyde Yancy, president-elect of the American Heart Association and medical director of the heart and vascular institute at Baylor College of Medicine. "But one or both could be manifestations of depression, which in turn leads to heart disease."

And while researchers are intrigued by the question of which comes first — depression or heart disease — the study points out that, in practice, it doesn't really matter. "It's hard to tease out which came first," says Whooley. "But our bottom line is that regardless of which is coming first, this study introduces a new pathway that might get at that risk, by focusing not so much on depression itself, but by getting at the behaviors that go along with depression." It may be easier to take Prozac than to take a jog, but as the study suggests, it may not always be as effective.

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For the first time since researchers began reporting national data on cancer, the statistics in a new report show that the rate of newly diagnosed cancers is declining in America; at the same time, the death rate for all cancers combined continues to fall.

"It's a validation of the efforts we are making in the fight against cancer," says Dr. Therese Bevers, medical director of clinical cancer prevention at the M.D. Anderson Cancer Center; she was not involved in the new paper. (See TIME's study of breast cancer around the world.)

Overall, cancer death rates have been dropping since the early 1990s — the most recent data suggest that death rates have decreased for 10 of the 15 most common causes of cancer death in the U.S. — in large part as a result of earlier screening and better treatments. But this year's Annual Report to the Nation on the Status of Cancer marks the first concurrent decline in incidence, or the rate of new cancer diagnoses. For both American men and women, the incidence of all cancers combined decreased 0.8% per year from 1999 through 2005. That overall decline was largely driven by men, however: cancer incidence dropped 1.8% per year from 2001 through 2005 for men but just 0.6% per year from 1998 through 2005 for women.

Over roughly the same time period, death rates from all cancers fell in both sexes: 1.8% per year on average from 2002 through 2005. Again, the decline was slightly steeper in men, whose cancer death rate fell 2% a year from 2001 through 2005; in women, the death rate dropped 1.6% per year from 2002 through 2005.

That's certainly good news. Indeed, the best indicator of progress is a declining death rate. But while the falling incidence rate suggests successful efforts at prevention, the real reasons behind the trend are not as clear-cut. Decreasing cancer rates may reflect a real reduction in cancer; they may also be a result of more frequent and effective screening, which can catch and cure pre-cancer, or they may reflect less frequent use of screens overall.

Although the trends are encouraging on the whole, some of the details of the data are knottier, highlighting gaps in access to health care. Cancer incidence was highest in black men, for instance, compared with men of other races. Among women, overall incidence was highest in white women, in whom the rate of lung cancer increased, while it remained stable in other populations. When parsed by race, cancer death rates were highest in blacks and lowest in Asians and Pacific Islanders. "The decrease in death rates could have been accelerated further by ensuring that all Americans have timely access to prevention measures," says the report's lead author, Ahmedin Jemal of the American Cancer Society. "We don't optimize what we know about cancer prevention and treatment to all segments of the population in the U.S."

That disparity is especially apparent when it comes to lung cancer. The report showed that lung-cancer incidence and death rates across the country varied widely, depending on the existence of smoking bans and the amount of state taxes on cigarettes. Data show, for example, that California, which was the first state to adopt a public-smoking ban, had the greatest decline in lung-cancer death rates in the U.S. — 2.8% per year from 1996 through 2005, which was twice the decline of many Midwestern and Southern U.S. states. Kentucky, which has low excise taxes on cigarettes and only partial smoking bans, had the country's highest lung-cancer incidence and mortality rates; it also had the highest percentage of cigarette smokers: nearly 30% of its adult population.

According to Bevers, California saw a decline in lung-cancer incidence even among women, a reversal of the overall trend in lung-cancer rates, which have been steadily increasing in women since 1975. Researchers say the difference in lung-cancer rates between the sexes — incidence has been dropping in men since 1991 — may owe in part to the fact that women in the U.S. began smoking decades later than men.

The annual report, which was produced by the American Cancer Society, the Centers for Disease Control and Prevention and the National Cancer Institute, also underscores the value of screening. Doctors currently have good tests — such as PSA tests, mammograms and colonoscopies — for detecting lung, prostate, breast and colorectal cancers. The death rates for these diseases have dropped, according to recent data. Meanwhile, mortality for liver, esophageal and pancreatic cancers have risen in many populations — and it is probably no coincidence that regular, reliable tests for those conditions don't exist.

The larger goals, say researchers, are earlier detection, better treatments and, most important, prevention. As more young people get vaccinated for hepatitis B, for instance, liver cancer, which is often a result of infection with the virus, may see its rates begin to drop in the coming years. But that depends on whether patients continue to use the screening methods currently available; other studies show that only about half of American adults get regular preventive care — including regular cancer screens like mammograms, PSA tests and colon exams.

Read a brief history of the Great American Smokeout.

See the Year in Medicine: From A to Z.

Earlier this month, the insurance company WellPoint announced a program that will allow employees of a Wisconsin printing company to get coverage for non-emergency surgeries in India. It's a first for WellPoint, but puts the insurer in good company. Over the past few years, some U.S. insurance companies — dismayed at losing income from uninsured Americans who get cheap surergies abroad or clients who choose to pay out of pocket for discount foreign surgeries rather than expensive in-network co-pays — have announced plans to include foreign medical procedures among those covered by health plans.

It's no wonder. The medical tourism industry has experienced massive growth over the past decade. Experts in the field say as many as 150,000 U.S. citizens underwent medical treatment abroad in 2006 — the majority in Asia and Latin America. That number grew to an estimated 750,000 in 2007 and could reach as high as 6 million by 2010. Patients are packing suitcases and boarding planes for everything from face lifts to heart bypasses to fertility treatments. (See The Year in Health, from A to Z.)

People have been traveling for centuries in the name of health, from ancient Greeks and Egyptians who flocked to hot springs and baths, to 18th and 19th century Europeans and Americans who journeyed to spas and remote retreats hoping to cure ailments like tuberculosis. But surgery abroad is a fairly modern phenomenon. As health costs rose in the 1980s and 1990s, patients looking for affordable options started considering their options offshore. So-called "tooth tourism" grew quickly, with Americans traveling to Central American countries like Costa Rica for dental bridges and caps not covered by their insurance. (A large percentage of today's medical tourism is for dental work, as much as 40% by some estimates.)

Many U.S. doctors and dentists were appalled at the idea of their patients turning to foreign hospitals for care that they considered dangerously cheap. But where many U.S. medical professionals saw great peril, countries like Cuba saw opportunities. Beginning in the late 1980s, the island country started programs to lure foreigners from India, Latin America and Europe for eye surgeries, heart procedures and cosmetic procedures. The Cuban government said it welcomed 2,000 medical tourists in 1990. (See pictures from an X-Ray studio.)

After Thailand's currency collapsed in 1997, the government directed its tourism officials to market the country as a hot destination for plastic surgery, hoping to boost revenues. Thailand quickly became the go-to country for comparatively inexpensive sex-change operations, where patients faced fees as low as $5,000, as well as looser requirements for pre-surgery psychological counseling. Thailand is now a destination spot for all types of plastic surgery as well as a host of routine medical procedures. Bumrungrad International Hospital in Bangkok is probably Thailand's best-known mecca for medical tourists, boasting patients from "over 190 countries" and an "International Patient Center" with interpreters and an airline ticket counter.

In recent years, companies all over the U.S. have sprung up to guide Americans through the insurance and logistical hurdles of surgery abroad, including many in U.S. border states affiliated with medical facilities in Mexico. The physician-managed MedToGo in Tempe, Arizona, founded in 2000, says its clients save "up to 75% on medical care" by getting it in Mexico. The Christua Muguerza hospital system — located in Mexico, but run by U.S.-based Christian hospital group since 2001 — includes a scrolling text box on its web site informing visitors how "very close to you" its Mexican facilities are. ("from Houston 1 hr 37 mins!" "from Chicago 3hrs 15 mins!") Meanwhile, New Zealand is trumpeting its expertise in hip and knee replacements and South Korea is enticing medical travelers with high-end non-medical amenities like golf.

For those who wrinkle their noses at the thought of going under the knife in a foreign, let alone still-developing, country, the American Medical Association introduced a set of guidelines in June for medical tourism. The AMA advocates that insurance companies, employers and others involved in the medical tourism field provide proper follow-up care, tell patients of their rights and legal recourse, use only accredited facilities, and inform patients of "the potential risks of combining surgical procedures with long flights and vacation activities," among other recommendations. Joint Commission International, a non-profit that certifies the safety and record of hospitals, has accredited some 200 foreign medical facilities, many in Spain, Brazil, Saudi Arabia, Turkey and the United Arab Emirates.

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I got married in August and, I'll admit it, I'm still slightly obsessed with reliving my own wedding day. But I don't think my friends want to reminisce anymore about the miraculously sunny hillside ceremony or the super rockin' dance party at the reception. I can't really turn to my husband either, the only other person as emotionally invested in my wedding as I, because he's 9,000 miles away in Vietnam. After the big to-do, which we spent a year planning long-distance, he's back living and working in Saigon and I'm back in Manhattan — living with my grandmother. Talk about a letdown.

It wasn't until I received an e-mail from a friend that I realized there was a name for what I was going through; the e-mail read in part: "Hope you're not too deep into the wedding blues (the depression you get after the wedding is over, that no one really tells you about)." Bingo.

Postnuptial depression may not be a clinical diagnosis, but it has entered the lexicon of marriage in the past few years, and newly hitched couples will tell you it's real. The blues typically hit early in married life, psychiatrists say, as newlyweds begin recognizing that expectations of how their partner or relationship will change post-wedding are unrealistic. Worse, once the Big Day has come and gone, couples are suddenly forced to step out of their much-cherished, and often long-lived, "bride" or "groom" spotlight and just get on with real life.

Dr. Michelle Gannon, a San Francisco psychologist who conducts the weekend workshop Marriage Prep 101 with her husband Patrick, says there's been an uptick lately in the number of recently married couples who enroll to deal with their post-wedding doldrums. Newlyweds often blog about it, while brides-to-be fret over the anticipation of it, on websites like TheKnot.com. Therapists say most people experience at least some minor disappointment as they settle into a new marriage, but 5% to 10% of newlyweds suffer strong enough remorse, sadness or frustration to prompt them to seek professional counseling.

Emily Summerhays, 30, felt regret immediately after her 2002 wedding ceremony. She found herself crying even as she said goodbye to guests at the reception. "It was sort of buyer's remorse — 'What did I just do? This is really permanent,'" she worried. That feeling of losing one's selfhood can be overwhelming, especially when it's coupled with the sense of duty to do everything as a pair, says Dr. Jane Greer, a marriage and family therapist based in New York City who has taught a seminar called Are You Ready for Commitment? "It's a question of how prepared you are to become 'we,'" she says.

For months into her marriage, Summerhays remained in a funk: "There was a lot of me being sad and sullen, wishing I could be married and somehow also be single." She felt afraid of sending the wrong message to her new husband. "Will you think I don't love you enough if I don't want to snuggle with you all night or if I leave you for the weekend?" she recalls thinking. And she felt trapped in her own melancholy, feeling ashamed that her new marriage wasn't living up to the fairy tale. Dr. Terry Eagan, medical director of the Moonview Sanctuary in Santa Monica, Calif., calls postnuptial depression the secret sadness — women who experience it are often too embarrassed to tell anyone, while men are simply less open with their feelings to begin with. "A lot of my friends had experienced it," Summerhays says. "It was just hard for us to admit that we were happy in our marriages and yet so indescribably sad on some level."

The so-called honeymoon period, say psychologists, really isn't. But so many couples buy into the myth that when they start arguing about sex, money or time — issues that all married couples battle over — it can seem catastrophic. Gannon finds herself correcting patients all the time: "Where did you get the idea that you weren't supposed to fight?" she says. "You are. It's normal." It's also normal to remain independent and to be responsible for your own happiness. "It's unreasonable to assume your partner is going to be everything to you," says Eagan.

Even couples who cohabit before marriage, and who have presumably tempered their expectations and reconciled their petty differences, are not immune to the day-after blues. "People who have been living together think they're going to feel something different once they're married," says Gannon. But there's no magical transformation that comes with signing a marriage certificate. In fact, if anything changes, it might be the couples' biology, which may only worsen post-wedding blues. When people are newly in love — or feel a rekindling of love just after getting engaged — their bodies release more of the feel-good hormones dopamine and oxytocin, which stimulate bonding. But as the relationship wears on, the levels of those hormones drop. That accounts in part for the fact that "in the transition from dating sex to married sex, the interest, frequency and effort goes down," says Gannon. But having less sex precisely when couples think they should be having more is understandably stressful.

For many couples, it's not about sex or arguing; despite good sex and open communication, they still feel adrift. The problem may be that after months consumed by wedding preparations and feeling like the center of attention, the sudden shift back to everyday life can be a shock. "I put a lot of time and effort into the wedding planning process," says Erin Hastings, 28, who got married in 2006 after an 18-month engagement. "Where do you redirect your energy once it's over?"

The answer, the Hastings learned, is on themselves and their marriage. "We have a date night every week, without fail," Erin says. Taking time to be with your partner and to think about one another other is always important. Ideally, before the wedding, Greer says, couples should take a step back and remind themselves of at least two things: 1) the reasons why their partner is the right person for them and 2) that their beloved's annoying little habits aren't going to disappear at "I do."

After the vows, to defeat the postnuptial blues, doctors say couples should get adequate rest and exercise; communicate constantly; focus on the benefits of marriage, such as having a built-in support system; and start thinking about the future in terms of family or finance. Women especially should also stop thinking of themselves as The Bride: throw out those wedding magazines, then plan some social events for after the honeymoon, so you have other parties to look forward to.

Since my husband and I are half a world apart, all I can do for now is rest and exercise, and learn to relinquish the spotlight — to one of my bridesmaids who just got engaged. It'll be worth it: for this particular friend, I know the high point of her wedding-roller-coaster will be another rockin' dance party.


On Nov. 19, scientists from Penn State University announced that they had succeeded in piecing together the majority of the woolly mammoth's genome, bringing the world one step closer to the Jurassic Park fantasy of using recovered DNA to bring an extinct species back to a shaggy, lumbering existence.



The wonders of eBay allowed the scientists to purchase a $130 bag of 20,000-year-old woolly-mammoth hair from a vendor in Moscow, and the wonders of science allowed them to extract the mammoth's genetic information in the most successful attempt to date to sequence an extinct animal's DNA. DNA in general breaks down after 60,000 years or so, making the possibility of a real Jurassic Park scenario — complete with flying pterodons and bloodthirsty tyrannosaurs — remote. Still, scientists see the completion of the genome as the first step to uncovering and understanding the reasons behind the mammoths' extinction, and the effort has brought the cloning question back to the public's mind in a (ahem) mammoth way.



Though Dolly the sheep was the first clone to be shoved into the limelight, in 1996, the process of human-directed cloning has existed since 1952. In that year, American researchers Robert Briggs and Thomas King successfully removed the nucleus of a tadpole's embryonic cell and transferred it to a donor cell, cloning 27 tadpoles in the experiment. This groundbreaking achievement landed the scientists the internationally lauded Charles Leopold Mayer Prize of the Académie des Sciences, making them the first Americans in history to receive the award. (Read TIME's first story about Dolly.)



Since Briggs and King's discovery, a veritable Noah's Ark of clones has been created, ranging from fish in 1963 to horses in 2003. Dolly's birth, at the Roslin Institute in Scotland, marked the first successful cloning of a mammal from an adult cell, proving that a complete animal could be grown from the DNA contained in cells from just about any part of another.



Attempts at cloning haven't stopped at the nonhuman animal kingdom: scientists have long speculated about cloning humans as well, but for the most part, ethical considerations have prevented any such notions from being put into practice. President George W. Bush urged Congress to enact legislation banning human cloning in 2002 after being "deeply troubled" by rumors that a Canada-based UFO cult had announced the birth of a successfully cloned baby girl. Though the claims were never substantiated, Congress passed the Human Cloning Prohibition Act in 2003. Congresswoman Sue Myrick, who supported the act, claimed that "anything other than a ban would license the most ghoulish and dangerous enterprise in human history." Religious groups also came out in force against human cloning; science was threatening to disrupt the natural order of life, they said, and researchers "playing God" were treading on dangerous existential territory. A representative of the U.S. Conference of Catholic Bishops hailed the passing of the bill, stating, "This vote reflects America's rejection of the notion that human life is a commodity to be created for experimentation."



Cloning has generated controversy outside of ethics questions as well — or at least, outside of these particular ethics questions. In 2004, South Korean researcher Hwang Woo Suk shot to fame after claims that his team had successfully extracted potentially disease-curing stem cells from a cloned human embryo. However, mere months later, Hwang's reputation dissolved after a Seoul National University panel concluded that much of his research was "intentionally fabricated." Hwang was accused of doctoring pictures of his supposed patient-specific stem-cell lines and was forced to resign. Though the controversy stunned South Korea, the nation resumed its cloning research, and in 2008 it unveiled seven Labrador retrievers, cloned from a drug-sniffing canine, that shared her superior narcotic-detecting abilities.



The genetic sequencing of the woolly mammoth, meanwhile, raises the similarly fraught but increasingly realistic possibility of cloning extinct animals, a process that Jurassic Park director Steven Spielberg has called "the science of eventuality." Still, scientist Stephan Schuster, who led the team at Penn State, isn't holding his breath. "What I'm trying to say is that there is a workable route to do that, but it is at this time technically, and cost-wise and time-wise, not feasible." Guess we'll just have to wait for Jurassic Park 4.

See the 50 best inventions of 2008.